Provider Demographics
NPI:1780258574
Name:MILLER, JAMIE M (SURGICAL FIRST ASSIT)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:SURGICAL FIRST ASSIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5233 DIJON DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4692
Mailing Address - Country:US
Mailing Address - Phone:225-761-8687
Mailing Address - Fax:225-761-8688
Practice Address - Street 1:5233 DIJON DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4692
Practice Address - Country:US
Practice Address - Phone:225-761-8687
Practice Address - Fax:225-761-8688
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA201440Medicaid