Provider Demographics
NPI:1922188085
Name:MILLER, PHILLIP HICKSON (DMD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:HICKSON
Last Name:MILLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N BELAIR RD
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3003
Mailing Address - Country:US
Mailing Address - Phone:703-860-6090
Mailing Address - Fax:
Practice Address - Street 1:104 KINGS CHAPEL RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-4001
Practice Address - Country:US
Practice Address - Phone:706-860-2244
Practice Address - Fax:706-860-2248
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0079741223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry