Provider Demographics
NPI:1740525195
Name:MILLER, JONATHAN G
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:G
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 1:1013 W UNIVERSITY AVE
Mailing Address - Street 2:SUITE 122
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-5340
Mailing Address - Country:US
Mailing Address - Phone:512-868-1100
Mailing Address - Fax:512-868-1105
Practice Address - Street 1:1013 W UNIVERSITY AVE
Practice Address - Street 2:SUITE 122
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-5340
Practice Address - Country:US
Practice Address - Phone:512-868-1100
Practice Address - Fax:512-868-1105
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11150237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist