Organization
JACK W MILLER
Active
Other names
Developmental Behavioral Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK W MILLER MD (PHYSICIAN)
(770) 830-7039
Entity
Organization
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
261QM0850X
Adult Mental Health Clinic/Center
Primary
044541
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000767709C
—
GA
Enumeration date
09/07/2006
Last updated
02/02/2011
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