Provider Demographics
NPI:1326578188
Name:MILES, TENIKA H (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:TENIKA
Middle Name:H
Last Name:MILES
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 GOVERNORS SQ STE A
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4861
Mailing Address - Country:US
Mailing Address - Phone:706-452-1043
Mailing Address - Fax:855-551-4053
Practice Address - Street 1:145 GOVERNORS SQ STE A
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4861
Practice Address - Country:US
Practice Address - Phone:706-452-1043
Practice Address - Fax:855-551-4053
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003210133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered