Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 074308 | GA |
N | 207QA0401X | Family Doctor - Addiction Medicine | 1034481A | IN |
N | 207QA0401X | Family Doctor - Addiction Medicine | ME125620 | FL |
N | 207VG0400X | Gynecologist | 01034481 | IN |
NPI | 1073512125 |
---|---|
Provider Name | Dr. Scott Thomas Miles |
First Address | St. Marys, GA 31558 |
Second Address | St. Marys, GA 31558 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 13/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D16136 | (02) | IN |