Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 063268 | GA |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 3776 | OK |
NPI | 1073596193 |
---|---|
Provider Name | Dr. Douglas Christian Miller |
First Address | Monroe, GA 30655 |
Second Address | Monroe, GA 30655-3210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 26/03/2018 |