Provider Demographics
NPI:1912181777
Name:MILLER, ARNOLD THOMAS III
Entity Type:Individual
Prefix:MR
First Name:ARNOLD
Middle Name:THOMAS
Last Name:MILLER
Suffix:III
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 1:6812 GREENMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:GREENWELL SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70739-4104
Mailing Address - Country:US
Mailing Address - Phone:225-303-4679
Mailing Address - Fax:225-262-7861
Practice Address - Street 1:6812 GREENMEADOW DR
Practice Address - Street 2:
Practice Address - City:GREENWELL SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70739-4104
Practice Address - Country:US
Practice Address - Phone:225-303-4679
Practice Address - Fax:225-262-7861
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1627895Medicaid