Provider Demographics
NPI:1952429235
Name:MILLER, ROSELYNN E (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROSELYNN
Middle Name:E
Last Name:MILLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 WARRENHALL LN NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-1938
Mailing Address - Country:US
Mailing Address - Phone:404-594-0004
Mailing Address - Fax:
Practice Address - Street 1:1112 WARRENHALL LN NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-1938
Practice Address - Country:US
Practice Address - Phone:404-919-7721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1591103TC0700X
GAPSY003394103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA725279494BMedicaid
AL121175Medicaid
AL121175Medicaid