Provider Demographics
NPI:1588199327
Name:MILLER, SCOTT EDWARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:EDWARD
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 MILLEDGE HALL
Mailing Address - Street 2:UNIVERSITY OF GEORGIA
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30602-5875
Mailing Address - Country:US
Mailing Address - Phone:706-542-4570
Mailing Address - Fax:
Practice Address - Street 1:352 MILLEDGE HALL
Practice Address - Street 2:UNIVERSITY OF GEORGIA
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30602-5875
Practice Address - Country:US
Practice Address - Phone:706-542-4570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2330103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist