Provider Demographics
NPI:1235899238
Name:MILLER, KAYLEE (CSFA)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:CSFA
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 404
Mailing Address - Street 2:
Mailing Address - City:BROOKS
Mailing Address - State:GA
Mailing Address - Zip Code:30205-0404
Mailing Address - Country:US
Mailing Address - Phone:404-862-0746
Mailing Address - Fax:470-514-5561
Practice Address - Street 1:4517 W MCINTOSH RD
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-6129
Practice Address - Country:US
Practice Address - Phone:404-862-0746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-19
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA246ZC0007XOtherNB0117582