Provider Demographics
NPI:1376632786
Name:MILLER, SAMUEL JONES III (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:JONES
Last Name:MILLER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 VERNON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4129
Mailing Address - Country:US
Mailing Address - Phone:706-884-6026
Mailing Address - Fax:706-884-0433
Practice Address - Street 1:1602 VERNON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4129
Practice Address - Country:US
Practice Address - Phone:706-884-6026
Practice Address - Fax:706-884-0433
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA021551207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000201572FMedicaid
F43088Medicare UPIN
GA000201572FMedicaid