Provider Demographics
NPI:1205829207
Name:MILLER, WILLIAM CHARLES JR (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CHARLES
Last Name:MILLER
Suffix:JR
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 1:203 SHIRLEY AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-2327
Mailing Address - Country:US
Mailing Address - Phone:912-384-7300
Mailing Address - Fax:912-384-5941
Practice Address - Street 1:203 SHIRLEY AVE
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2327
Practice Address - Country:US
Practice Address - Phone:912-384-7300
Practice Address - Fax:912-384-5941
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024302208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000261324CMedicaid
GAD46147Medicare UPIN