Provider Demographics
NPI:1649509944
Name:MILLER PSYCHIATRY CLINIC, INC.
Entity type:Organization
Organization Name:MILLER PSYCHIATRY CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:CHANDA
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-871-8663
Mailing Address - Street 1:127 WILSONG VILLAGE TRL
Mailing Address - Street 2:
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866-7185
Mailing Address - Country:US
Mailing Address - Phone:662-869-7300
Mailing Address - Fax:662-869-7300
Practice Address - Street 1:1005 CITY AVE N
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:MS
Practice Address - Zip Code:38663-1414
Practice Address - Country:US
Practice Address - Phone:662-837-1561
Practice Address - Fax:662-837-1566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS191422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1265533038OtherNPI