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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184697815 NPPES
Georgia MEDICAID 000396492A

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