Provider Demographics
NPI:1629149430
Name:MILLER, CONRAD N JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CONRAD
Middle Name:N
Last Name:MILLER
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 4624
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-4624
Mailing Address - Country:US
Mailing Address - Phone:478-745-7878
Mailing Address - Fax:478-745-1636
Practice Address - Street 1:1818 FORSYTH STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-1636
Practice Address - Country:US
Practice Address - Phone:478-745-1818
Practice Address - Fax:478-745-1636
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2023-04-03
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Provider Licenses
StateLicense IDTaxonomies
GA040963207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA297072OtherGHI
GA000684615GMedicaid
GAP00187716OtherMEDICARE RAILROAD
GA000684615GOtherPEACH STATE HEALTH PLANS OF GEORGIA
GA08BBRPXOtherGEORGIA BETTER HEALTHCARE
GA808257OtherBLUE CROSS BLUE SHIELD OF GEORGIA
GA297072OtherWELLCARE OF GEORGIA
GAF88605Medicare UPIN
GA08BBRPXOtherGEORGIA BETTER HEALTHCARE
GA08BBRPXMedicare PIN