Provider Demographics
NPI:1467675702
Name:MILLER, LEAH HARRIS (NP)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:HARRIS
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 EAST VILLANOW STREET
Mailing Address - Street 2:CHI - MEMORIAL FAMILY PRACTICE ASSOCIATES - LAFAYETTE
Mailing Address - City:LAFAYETTE
Mailing Address - State:GA
Mailing Address - Zip Code:30728
Mailing Address - Country:US
Mailing Address - Phone:706-638-1606
Mailing Address - Fax:706-638-9987
Practice Address - Street 1:611 EAST VILLANOW STREET
Practice Address - Street 2:CHI - MEMORIAL FAMILY PRACTICE ASSOCIATES - LAFAYETTE
Practice Address - City:LAFAYETTE
Practice Address - State:GA
Practice Address - Zip Code:30728
Practice Address - Country:US
Practice Address - Phone:706-638-1606
Practice Address - Fax:706-638-9987
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA189150363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3341160Medicare PIN
GA50BBLKJMedicare PIN