1831366004 NPI number — MILLER PSYCHOLOGICAL ASSOCIATES LLC

Table of content: (NPI 1831366004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831366004 NPI number — MILLER PSYCHOLOGICAL ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILLER PSYCHOLOGICAL ASSOCIATES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MILLER PSYCHOLOGICAL ASSOCIATES LLC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831366004
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6740 JAMESTOWN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALPHARETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30005-3030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-833-9966
Provider Business Mailing Address Fax Number:
678-513-0743

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6740 JAMESTOWN DR
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
ALPHARETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30005-3030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-217-5792
Provider Business Practice Location Address Fax Number:
678-513-0743
Provider Enumeration Date:
05/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
SUE
Authorized Official Middle Name:
BARRICK
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
770-833-9966

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1336470780 . This is a "KAREN TANTILLO LCSW" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1043327612 . This is a "DR. SUE MILLER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1932312774 . This is a "STACEY J. NYMAN, MS, NCC, LAPC" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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