Provider Demographics
NPI:1629109863
Name:MILLER, DEBORAH C (APRN BC)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:C
Last Name:MILLER
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1361 JENNINGS MILL ROAD
Mailing Address - Street 2:BUILDING 200 SUITE 201
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622
Mailing Address - Country:US
Mailing Address - Phone:706-316-1908
Mailing Address - Fax:706-316-2062
Practice Address - Street 1:1361 JENNINGS MILL ROAD
Practice Address - Street 2:BUILDING 200 SUITE 201
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622
Practice Address - Country:US
Practice Address - Phone:706-316-1908
Practice Address - Fax:706-316-2062
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN081032 CNS163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA301102464AMedicaid