Miller, Dallas Mark
Miller, Dallas Mark is an individual health care provider with primary practice located at 2704 N Oak St Building F, Valdosta GA 31602-1744. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Vascular Surgery. Allopathic & Osteopathic Physicians / Surgery is his primary health care specialty. Miller, Dallas Mark can be contacted via phone (229) 242-4996.Contact Information
Primary practice address
2704 N Oak St Building F
Valdosta GA 31602-1744
Phone: (229) 242-4996
Fax: (229) 242-2306
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 026898 | Georgia |
| Allopathic & Osteopathic Physicians / Vascular Surgery | 2086S0129X | 026898 | Georgia |
Profile Details
| NPI number | 1184697815 |
|---|---|
| LBN Legal business name | Miller, Dallas Mark |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 13th, 2006 |
| Last updated | Sep 20th, 2012 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1184697815 | NPPES |
| Georgia | MEDICAID | 000396492A |
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