Provider Demographics
NPI:1487661559
Name:MILLER, MARCIA O (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:O
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:OWEN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 15849
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-2549
Mailing Address - Country:US
Mailing Address - Phone:912-819-5999
Mailing Address - Fax:
Practice Address - Street 1:5354 REYNOLDS ST STE 424
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6011
Practice Address - Country:US
Practice Address - Phone:912-819-5999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49010207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064298300Medicaid
D51411Medicare UPIN
FL064298300Medicaid