Individual
JACK W MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
100 PROFESSIONAL PL, STE 104, CARROLLTON, GA 30117-3874
(770) 830-7039
(770) 830-7149
Mailing address
100 PROFESSIONAL PL, STE 104, CARROLLTON, GA 30117-3874
(770) 830-7039
(770) 830-7149
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
044541
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000767709C
—
GA
Enumeration date
12/29/2006
Last updated
02/12/2026
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