Provider Demographics
NPI:1265533038
Name:MILLER, AMY CHANDA (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:CHANDA
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 UNION BELLE BLVD
Mailing Address - Street 2:
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866-9771
Mailing Address - Country:US
Mailing Address - Phone:662-869-3042
Mailing Address - Fax:662-869-3405
Practice Address - Street 1:110 UNION BELLE BLVD
Practice Address - Street 2:
Practice Address - City:SALTILLO
Practice Address - State:MS
Practice Address - Zip Code:38866-9771
Practice Address - Country:US
Practice Address - Phone:662-869-3042
Practice Address - Fax:662-869-3405
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS191422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS640662976OtherTAX IDENTIFICATION NUMBER