Provider Demographics
NPI:1346263175
Name:MILLER, FREDD E (MD)
Entity Type:Individual
Prefix:
First Name:FREDD
Middle Name:E
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 MOUNT VERNON HWY NE STE 500
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4280
Mailing Address - Country:US
Mailing Address - Phone:678-222-3145
Mailing Address - Fax:
Practice Address - Street 1:755 MOUNT VERNON HWY NE STE 500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4280
Practice Address - Country:US
Practice Address - Phone:678-222-3145
Practice Address - Fax:678-222-6178
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043092207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11SCCTKMedicare ID - Type Unspecified
GAG71154Medicare UPIN