Provider Demographics
NPI:1902436975
Name:GREGORY DEVON MILLER PLLC
Entity Type:Organization
Organization Name:GREGORY DEVON MILLER PLLC
Other - Org Name:SEACOAST HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:DEVON
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:904-229-5038
Mailing Address - Street 1:4856 FIRST COAST HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-5495
Mailing Address - Country:US
Mailing Address - Phone:904-229-5038
Mailing Address - Fax:
Practice Address - Street 1:4856 FIRST COAST HWY STE 1
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-5495
Practice Address - Country:US
Practice Address - Phone:904-229-5038
Practice Address - Fax:904-592-5343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-18
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health