Individual
JERRY MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
105 W STONE DR, STE 3A, KINGSPORT, TN 37660-3256
(423) 392-6200
Mailing address
PO BOX 9, KINGSPORT, TN 37662-0009
(423) 857-2066
(423) 857-2070
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0101017451
VA
207Q00000X
Family Medicine Physician
Primary
MD 5663
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3173496
—
TN
Enumeration date
06/10/2005
Last updated
09/22/2009
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