Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 8425 | GA |
NPI | 1003339912 |
---|---|
Provider Name | Serena Miller |
First Address | Albany, GA 31721-2984 |
Second Address | Albany, GA 31707-2802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2017 |
Last Update Date | 23/07/2017 |