Provider Demographics
NPI:1861098683
Name:MILLER, GERRAILL TYRONE
Entity type:Individual
Prefix:
First Name:GERRAILL
Middle Name:TYRONE
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2745 BRISTOL HILL CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-7705
Mailing Address - Country:US
Mailing Address - Phone:513-557-1405
Mailing Address - Fax:
Practice Address - Street 1:2745 BRISTOL HILL CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-7705
Practice Address - Country:US
Practice Address - Phone:513-557-1405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health