Individual
MS. PHYLLIS WARDRETT MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW,LCSW
Contact information
Practice address
204 CHURCH ST, DECATUR, GA 30030-3328
(404) 626-9690
(404) 377-5644
Mailing address
204 CHURCH ST, DECATUR, GA 30030-3328
(404) 626-9690
(404) 377-5644
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
CSW000649
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003112377A
—
GA
01
—
132600
CENPATICO
GA
01
—
1902141617
BLUE CROSS/BLUE SHIELD OF GEORGIA
GA
01
—
3561762
CIGNA INSURANCE
—
01
—
753207
WELLCARE
—
Enumeration date
09/07/2011
Last updated
11/17/2015
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