Provider Demographics
NPI:1962376749
Name:MILLER, JOHN VINCENT
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:VINCENT
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 1:840 COLD HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-6322
Mailing Address - Country:US
Mailing Address - Phone:615-962-0731
Mailing Address - Fax:
Practice Address - Street 1:4255 CHAMBLEE TUCKER RD
Practice Address - Street 2:
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340-4501
Practice Address - Country:US
Practice Address - Phone:770-493-7922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor