Provider Demographics
NPI:1639142524
Name:MILLER, ROBERT G (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2996 KATE BOND RD STE 405
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-4063
Mailing Address - Country:US
Mailing Address - Phone:870-394-4832
Mailing Address - Fax:866-345-0188
Practice Address - Street 1:2996 KATE BOND RD STE 405
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-4063
Practice Address - Country:US
Practice Address - Phone:870-394-4832
Practice Address - Fax:866-345-0188
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18647207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3859928Medicaid
TN4198150OtherBCBS OF TN
TN38599211Medicare PIN
TNF31284Medicare UPIN
TN38599212Medicare PIN
TN3859925Medicare ID - Type Unspecified