Provider Demographics
NPI:1114143765
Name:JOHN E MILLER MD PC
Entity Type:Organization
Organization Name:JOHN E MILLER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-296-0022
Mailing Address - Street 1:1949 GUNBARREL RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3188
Mailing Address - Country:US
Mailing Address - Phone:423-296-0022
Mailing Address - Fax:423-296-0025
Practice Address - Street 1:1949 GUNBARREL RD
Practice Address - Street 2:SUITE 150
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3188
Practice Address - Country:US
Practice Address - Phone:423-296-0022
Practice Address - Fax:423-296-0025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMDO20155174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNF24759Medicare UPIN
TN3082118Medicare ID - Type Unspecified