Provider Demographics
NPI:1396491247
Name:MILLER, CICELY (NP)
Entity type:Individual
Prefix:
First Name:CICELY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 N LYERLY ST
Mailing Address - Street 2:STE 100
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-2743
Mailing Address - Country:US
Mailing Address - Phone:423-826-8000
Mailing Address - Fax:423-702-7917
Practice Address - Street 1:251 N LYERLY ST STE 100
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2743
Practice Address - Country:US
Practice Address - Phone:423-826-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-01
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAA-NP000641363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty