Provider Demographics
NPI:1043343718
Name:BRETT, MILES ELI (MD)
Entity Type:Individual
Prefix:DR
First Name:MILES
Middle Name:ELI
Last Name:BRETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 WINDY HILL RD SE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8664
Mailing Address - Country:US
Mailing Address - Phone:770-952-1032
Mailing Address - Fax:770-952-8579
Practice Address - Street 1:2520 WINDY HILL RD SE
Practice Address - Street 2:SUITE 301
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8664
Practice Address - Country:US
Practice Address - Phone:770-952-1032
Practice Address - Fax:770-952-8579
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017041207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00173104AMedicaid
GA00173104AMedicaid