Miller, Jack W

Miller, Jack W is an sole proprietor health care provider with primary practice located at 100 Professional Pl Ste 104, Carrollton GA 30117-3874. He recently has only one registered license in Allopathic & Osteopathic Physicians / Developmental – Behavioral Pediatrics, which is considered as his primary health care specialty. Miller, Jack W can be contacted via phone (770) 830-7039.

Contact Information

Primary practice address
100 Professional Pl Ste 104 Carrollton GA 30117-3874
Phone: (770) 830-7039
Fax: (770) 830-7149
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Developmental – Behavioral Pediatrics 2080P0006X 044541 Georgia

Profile Details

NPI number 1275699514
LBN Legal business name Miller, Jack W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 29th, 2006
Last updated Aug 6th, 2015 - about 11 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 1275699514 NPPES
Georgia MEDICAID 000767709C

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