Provider Demographics
NPI:1003033697
Name:MILLER, JESSICA BETH (DPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:BETH
Last Name:MILLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CIRCLE 75 PKWY SE
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3035
Mailing Address - Country:US
Mailing Address - Phone:770-953-6929
Mailing Address - Fax:770-953-6972
Practice Address - Street 1:6300 HOSPITAL PKWY
Practice Address - Street 2:SUITE 400
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1828
Practice Address - Country:US
Practice Address - Phone:678-205-4261
Practice Address - Fax:678-417-7187
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29814225100000X
GAPT009414225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00785965OtherRR MEDICARE
202I654503Medicare PIN