Provider Demographics
NPI:1326334384
Name:MILLER, LAUREN COURTNEY (MD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:COURTNEY
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:COURTNEY
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 407
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30475-0407
Mailing Address - Country:US
Mailing Address - Phone:912-538-8484
Mailing Address - Fax:912-538-8665
Practice Address - Street 1:125 CHURCH ST
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-4770
Practice Address - Country:US
Practice Address - Phone:912-538-8484
Practice Address - Fax:912-538-8665
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4799208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics