Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 43697 | TN |
NPI | 1144403171 |
---|---|
Provider Name | Lewis Mccoy Miller III |
First Address | Chattanooga, TN 37403-1405 |
Second Address | Chattanooga, TN 37403-1405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2007 |
Last Update Date | 04/08/2008 |