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
State | License ID | Taxonomies |
---|---|---|
GA | 189150 | 363L00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TN | 3341160 | Medicare PIN | |
GA | 50BBLKJ | Medicare PIN |