Provider Demographics
NPI:1295972214
Name:MILLER, PHILLIP GARDENER
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:GARDENER
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 1:739 CEDAR GATE RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:VA
Mailing Address - Zip Code:24574
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:739 CEDAR GATE RD
Practice Address - Street 2:MILLERS HOME IMPROVEMENT
Practice Address - City:MONROE
Practice Address - State:VA
Practice Address - Zip Code:24574
Practice Address - Country:US
Practice Address - Phone:434-929-1526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2705102161171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications