Provider Demographics
NPI:1194845115
Name:MILLER, JOSEPH BLANKS III (MS)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:BLANKS
Last Name:MILLER
Suffix:III
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:315 W PONCE DE LEON AVE
Mailing Address - Street 2:SUITE 780
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2400
Mailing Address - Country:US
Mailing Address - Phone:404-210-0993
Mailing Address - Fax:404-292-1846
Practice Address - Street 1:315 W PONCE DE LEON AVE
Practice Address - Street 2:SUITE 780
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2400
Practice Address - Country:US
Practice Address - Phone:404-210-0993
Practice Address - Fax:404-292-1846
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1644101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional