Provider Demographics
NPI:1538502570
Name:MILES, T. (LPN)
Entity Type:Individual
Prefix:
First Name:T.
Middle Name:
Last Name:MILES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 ROSWELL RD
Mailing Address - Street 2:#1616
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-3662
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1675 ROSWELL RD
Practice Address - Street 2:#1616
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-3662
Practice Address - Country:US
Practice Address - Phone:770-771-2597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN085333164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse