Provider Demographics
NPI:1679041107
Name:MILLER, ANTONIO (RN)
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 E OAKLAND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CAMILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31730-1529
Mailing Address - Country:US
Mailing Address - Phone:229-336-9769
Mailing Address - Fax:
Practice Address - Street 1:94 E OAKLAND AVE STE A
Practice Address - Street 2:
Practice Address - City:CAMILLA
Practice Address - State:GA
Practice Address - Zip Code:31730-1529
Practice Address - Country:US
Practice Address - Phone:229-336-9769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-02
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN153026363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily