Provider Demographics
NPI:1356315535
Name:MILES, SEAN M (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:M
Last Name:MILES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1605 HIGHWAY 34 E
Mailing Address - Street 2:STE #A2
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2191
Mailing Address - Country:US
Mailing Address - Phone:770-251-2000
Mailing Address - Fax:770-251-2034
Practice Address - Street 1:1605 HIGHWAY 34 E
Practice Address - Street 2:STE #A2
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2191
Practice Address - Country:US
Practice Address - Phone:770-251-2000
Practice Address - Fax:770-251-2034
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2011-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA052084207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H76576Medicare UPIN
GA08BBQWWMedicare ID - Type Unspecified