Provider Demographics
NPI:1922171784
Name:MILLER, DANIEL LEWIS (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:LEWIS
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 EH CT
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-2198
Mailing Address - Country:US
Mailing Address - Phone:912-267-4900
Mailing Address - Fax:912-267-4960
Practice Address - Street 1:3400 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4755
Practice Address - Country:US
Practice Address - Phone:912-466-5800
Practice Address - Fax:912-265-1524
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA040739207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G24537Medicare UPIN