Provider Demographics
NPI:1437198280
Name:MILLER, JILL DANA (MD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:DANA
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:DANA
Other - Last Name:BERNSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1510 HUDSON BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5020
Mailing Address - Country:US
Mailing Address - Phone:404-785-8660
Mailing Address - Fax:404-785-8730
Practice Address - Street 1:1510 HUDSON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5020
Practice Address - Country:US
Practice Address - Phone:404-785-8660
Practice Address - Fax:404-785-8730
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234592207L00000X, 208000000X, 2080P0204X
GA897602080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403588700Medicaid
PA1008314420001Medicaid
NC89066FTMedicaid
VA006739580Medicaid
VA006739580Medicaid
H84806Medicare UPIN