Provider Demographics
NPI:1881826410
Name:MILLER, DAVID CAMERON
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:CAMERON
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4912 PIKES POND RD
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:31636-3262
Mailing Address - Country:US
Mailing Address - Phone:229-834-2322
Mailing Address - Fax:
Practice Address - Street 1:10650 SW 46TH ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:FL
Practice Address - Zip Code:32052-3732
Practice Address - Country:US
Practice Address - Phone:386-792-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-15
Last Update Date:2009-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45654163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health