Provider Demographics
NPI:1831149723
Name:MILLER FOOT & ANKLE HEALTHCARE, INC.
Entity type:Organization
Organization Name:MILLER FOOT & ANKLE HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:770-386-1234
Mailing Address - Street 1:3450 ACWORTH DUE WEST RD, SUITE 320
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-1002
Mailing Address - Country:US
Mailing Address - Phone:770-386-1234
Mailing Address - Fax:678-574-5549
Practice Address - Street 1:650 HENDERSON DRIVE, SUITE 505
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3723
Practice Address - Country:US
Practice Address - Phone:770-386-1234
Practice Address - Fax:770-386-1250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000776213ES0103X, 213E00000X, 213EP1101X
GA000776213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA362436212AMedicaid
LA1756393OtherMEDICAID
GA5732020001Medicare NSC
LA1756393OtherMEDICAID
GAGRP7697Medicare Oscar/Certification
GA362436212AMedicaid
GA48SCCTPMedicare PIN