Provider Demographics
NPI:1740228600
Name:MILLER, THERESA P (PA)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:P
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 746450
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6450
Mailing Address - Country:US
Mailing Address - Phone:251-434-3626
Mailing Address - Fax:251-445-2464
Practice Address - Street 1:2451 UNIVERSITY HOSPITAL DR BLDG SUITE102
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2300
Practice Address - Country:US
Practice Address - Phone:251-471-7844
Practice Address - Fax:251-471-7898
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA-231363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1505676Medicaid
AL009919425Medicaid
AL51514409OtherBLUE CROSS
AL009913955Medicaid
MS07171083Medicaid
FL292365300Medicaid
AL009913955Medicaid
AL051553152Medicare ID - Type Unspecified
AL970030352Medicare ID - Type UnspecifiedRAILROAD PGBA