Individual
RONNISHA MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NIP
Contact information
Practice address
235 NORTHSIDE DR, VALDOSTA, GA 31602-1859
(229) 469-0049
Mailing address
235 NORTHSIDE DR, VALDOSTA, GA 31602-1859
(229) 469-0049
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
863341051
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
86-3341051
NATIONAL MED SPA ASSOCIATION
GA
Enumeration date
04/06/2022
Last updated
04/06/2022
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