Provider Demographics
NPI:1720022155
Name:MILLER, JOHN JUSTUS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JUSTUS
Last Name:MILLER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1100 JOHNSON FERRY RD NE
Mailing Address - Street 2:SUITE 593
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1709
Mailing Address - Country:US
Mailing Address - Phone:404-255-9096
Mailing Address - Fax:404-255-9097
Practice Address - Street 1:155 MEDICAL WAY
Practice Address - Street 2:SUITE E
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274
Practice Address - Country:US
Practice Address - Phone:770-907-9400
Practice Address - Fax:770-907-1213
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2010-02-12
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Provider Licenses
StateLicense IDTaxonomies
GA057132207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI14295Medicare UPIN