Provider Demographics
NPI:1346384674
Name:MILLER, MICHAEL ALLLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALLLEN
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 WATER PL SE STE 220
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2042
Mailing Address - Country:US
Mailing Address - Phone:770-916-9020
Mailing Address - Fax:
Practice Address - Street 1:1830 WATER PL SE STE 220
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2042
Practice Address - Country:US
Practice Address - Phone:770-916-9020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY 2060103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling