Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | POD000776 | GA |
N | 222Z00000X | Podiatrist | POD000776 | GA |
Y | 213EP1101X | Primary Podiatric Medicine | POD000776 | GA |
N | 213ES0103X | Foot & Ankle Surgery | 000776 | GA |
N | 213ES0103X | Foot & Ankle Surgery | POD000776 | GA |
NPI | 1104816941 |
---|---|
Provider Name | Mr. Michael S. Miller |
First Address | Kennesaw, GA 30144-1002 |
Second Address | Kennesaw, GA 30144-1002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2005 |
Last Update Date | 18/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1756393 | (05) | LA |
362436212A | (05) | GA |
U61909 | (02) |