Provider Demographics
NPI:1255102547
Name:MILLER, JAMES E
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
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 1:352 THOMAS HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:LUCASVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45648-8890
Mailing Address - Country:US
Mailing Address - Phone:740-357-6436
Mailing Address - Fax:
Practice Address - Street 1:352 THOMAS HOLLOW RD
Practice Address - Street 2:
Practice Address - City:LUCASVILLE
Practice Address - State:OH
Practice Address - Zip Code:45648-8890
Practice Address - Country:US
Practice Address - Phone:740-357-6436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH23174171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor