Individual
JERRY ALLAN MILLER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1245 AUGUSTA WEST PKWY, AUGUSTA, GA 30909-1807
(706) 868-0389
(706) 651-0729
Mailing address
1245 AUGUSTA WEST PKWY, AUGUSTA, GA 30909-1807
(706) 868-0389
(706) 651-0729
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
018708
GA
2080A0000X
Pediatric Adolescent Medicine Physician
018708
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000199746C
—
GA
Enumeration date
03/29/2006
Last updated
03/18/2016
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