Provider Demographics
NPI:1710258298
Name:MILLER, MICHAEL A (BC-HIS, HAS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:MILLER
Suffix:
Gender:M
Credentials:BC-HIS, HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2935 N ASHLEY ST STE 101
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1786
Mailing Address - Country:US
Mailing Address - Phone:229-245-1122
Mailing Address - Fax:229-245-1020
Practice Address - Street 1:2935 N ASHLEY ST STE 101
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1786
Practice Address - Country:US
Practice Address - Phone:229-245-1122
Practice Address - Fax:229-245-1020
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
237700000X
GAHADS000710237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist