Provider Demographics
NPI:1821030867
Name:MILLER, JERI L (MD)
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 HILLCREST PKWY.
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021
Mailing Address - Country:US
Mailing Address - Phone:478-272-7411
Mailing Address - Fax:478-274-9809
Practice Address - Street 1:908 HILLCREST PKWY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021
Practice Address - Country:US
Practice Address - Phone:478-272-7411
Practice Address - Fax:478-274-9809
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA30835207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000458147QMedicaid
GA000458147SMedicaid
GA000458147SMedicaid
GA000458147QMedicaid
GAP00313041Medicare PIN