Provider Demographics
NPI:1770584971
Name:MILLER, JEFFREY J (PA-C)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:J
Last Name:MILLER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5651 FRIST BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2054
Mailing Address - Country:US
Mailing Address - Phone:615-391-4545
Mailing Address - Fax:615-391-4546
Practice Address - Street 1:5651 FRIST BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2054
Practice Address - Country:US
Practice Address - Phone:615-391-4545
Practice Address - Fax:615-391-4546
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1166363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4121917OtherBCBS
TN4066914OtherBCBS
TN36226522Medicaid
TN4066914OtherBCBS
TN36626521Medicare PIN
Q24418Medicare UPIN