Provider Demographics
NPI:1821431107
Name:MILLER MEDICAL CLINIC
Entity Type:Organization
Organization Name:MILLER MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERSIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-624-6885
Mailing Address - Street 1:1900 KIRBY PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3653
Mailing Address - Country:US
Mailing Address - Phone:901-624-6885
Mailing Address - Fax:901-624-2945
Practice Address - Street 1:1900 KIRBY PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3653
Practice Address - Country:US
Practice Address - Phone:901-624-6885
Practice Address - Fax:901-624-2945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000025954261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty