Provider Demographics
NPI:1992810246
Name:MILLER, JACQUELINE WHITE (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:WHITE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:105 TANA DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7538
Mailing Address - Country:US
Mailing Address - Phone:770-488-5061
Mailing Address - Fax:770-488-4639
Practice Address - Street 1:1670 CLAIRMONT RD
Practice Address - Street 2:SURGICAL SERVICES
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4004
Practice Address - Country:US
Practice Address - Phone:770-488-5061
Practice Address - Fax:770-488-4639
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA038648208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery