Provider Demographics
NPI:1710741939
Name:MILLER, CAMILLE ALEXANDRA (MS)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:ALEXANDRA
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 HOWELL MILL RD NW STE 625
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-3185
Mailing Address - Country:US
Mailing Address - Phone:404-425-7947
Mailing Address - Fax:404-845-1259
Practice Address - Street 1:1800 HOWELL MILL RD NW STE 625
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-3185
Practice Address - Country:US
Practice Address - Phone:404-425-7300
Practice Address - Fax:404-845-1259
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAE025313146N00000X
GA447170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic