Provider Demographics
NPI:1871861716
Name:EARLY MILLER PERSONAL SUPPORT (COMP)
Entity Type:Organization
Organization Name:EARLY MILLER PERSONAL SUPPORT (COMP)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BARANKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-430-0416
Mailing Address - Street 1:302 DAMASCUS STREET
Mailing Address - Street 2:
Mailing Address - City:BLAKELY
Mailing Address - State:GA
Mailing Address - Zip Code:39823-3346
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:302 DAMASCUS STREET
Practice Address - Street 2:
Practice Address - City:BLAKELY
Practice Address - State:GA
Practice Address - Zip Code:39823-3346
Practice Address - Country:US
Practice Address - Phone:229-723-4325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities