Provider Demographics
NPI:1356587588
Name:MILLER, JAY A (PA)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:A
Last Name:MILLER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:275 SHERATON BLVD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-1359
Mailing Address - Country:US
Mailing Address - Phone:478-745-5779
Mailing Address - Fax:
Practice Address - Street 1:275 SHERATON BLVD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-1359
Practice Address - Country:US
Practice Address - Phone:478-745-5779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA97WCHDXMedicare PIN