Provider Demographics
NPI:1346637048
Name:MILLER, JONATHAN ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ALLEN
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 1:5243 LITTLE DEBBIE PKWY STE 111
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-4515
Mailing Address - Country:US
Mailing Address - Phone:423-206-2777
Mailing Address - Fax:
Practice Address - Street 1:5243 LITTLE DEBBIE PKWY STE 111
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-4515
Practice Address - Country:US
Practice Address - Phone:423-206-2777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN60832207N00000X
AL38079207N00000X
TN61190207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty