Provider Demographics
NPI:1336159946
Name:MILLER, JOHN EDWIN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWIN
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7268 JARNIGAN RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3096
Mailing Address - Country:US
Mailing Address - Phone:423-296-0022
Mailing Address - Fax:423-296-0025
Practice Address - Street 1:7268 JARNIGAN RD
Practice Address - Street 2:SUITE 304
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3096
Practice Address - Country:US
Practice Address - Phone:423-296-0022
Practice Address - Fax:423-296-0025
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMDO20155207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3082118Medicaid
TN3082118Medicare ID - Type Unspecified
TN3082118Medicaid