Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | AT003268 | GA |
Y | 213ES0000X | Sports Medicine | AT003268 | GA |
NPI | 1043724040 |
---|---|
Provider Name | Chesnee Miller |
First Address | Albany, GA 31707-3023 |
Second Address | Albany, GA 31707-3023 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2017 |
Last Update Date | 29/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AT003268 | NATA BOC (203041) (01) | GA |