Provider Demographics
NPI:1366492639
Name:MILLER, CHARLES G II (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:G
Last Name:MILLER
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 LOVE ST
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:TN
Mailing Address - Zip Code:37650-1734
Mailing Address - Country:US
Mailing Address - Phone:423-735-4160
Mailing Address - Fax:423-735-4159
Practice Address - Street 1:500 LOVE ST
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650-1734
Practice Address - Country:US
Practice Address - Phone:423-735-4160
Practice Address - Fax:423-735-4159
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO0000001740207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine