Basic Information
| Provider Information | |||||||||
| NPI: | 1780671750 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9247 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319089247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063227884 | ||||||||
| FaxNumber: | 7066602118 | ||||||||
| Practice Location | |||||||||
| Address1: | 610 19TH ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319011528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063227884 | ||||||||
| FaxNumber: | 7066602118 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2005 | ||||||||
| LastUpdateDate: | 07/31/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 32433 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00405039C | 05 | GA | MEDICAID | 000405039F | 05 | GA | MEDICAID | 080038749 | 01 | GA | RAIL ROAD MEDICARE | OTHER | 202I071209 | 01 | GA | MEDICARE PTAN | OTHER |