Organization
LISA D MILLER MD PEDIATRICS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA DAWN MILLER MD (OWNER/PHYSICIAN)
(770) 788-1077
Entity
Organization
Contact information
Practice address
4152 BAKER ST NE, COVINGTON, GA 30014-1404
(770) 788-1077
(770) 788-0768
Mailing address
4152 BAKER ST NE, COVINGTON, GA 30014-1404
(770) 788-1077
(770) 788-0768
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
013449
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00618945D
—
GA
05
—
00618945E
—
GA
01
—
581934
BCBS
GA
Enumeration date
11/10/2005
Last updated
09/16/2008
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