Provider Demographics
NPI:1093764425
Name:MILLER, KEVIN GARRETT (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:GARRETT
Last Name:MILLER
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:PO BOX 200096
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-9002
Mailing Address - Country:US
Mailing Address - Phone:678-928-9759
Mailing Address - Fax:678-928-9759
Practice Address - Street 1:960 JOE FRANK HARRIS PKWY SE
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2129
Practice Address - Country:US
Practice Address - Phone:678-928-9759
Practice Address - Fax:678-928-9759
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0561982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA805644863Medicaid
GAGRP1205OtherGROUP MEDICARE ID
GA30BDMBTMedicare ID - Type Unspecified
GA805644863Medicaid