Provider Demographics
NPI:1447255864
Name:MILLER, DEBRA R (MD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:R
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:631 PROFESSIONAL DR STE 450
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-3370
Mailing Address - Country:US
Mailing Address - Phone:770-963-8030
Mailing Address - Fax:770-339-9577
Practice Address - Street 1:1000 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7694
Practice Address - Country:US
Practice Address - Phone:678-312-5600
Practice Address - Fax:770-339-2135
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041898174400000X, 207RH0003X
NC2013-01738207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00720167AMedicaid
NC83BBBJTMedicare PIN
GA00720167DMedicaid
GA1588792881OtherSUPPLIER NPI NUMBER (AUSTELL)
GA000720167EMedicaid
GA0741780005Medicare NSC
GA0741780012Medicare NSC
GA00720167AMedicaid
GA1790951788OtherSUPPLIER NPI NUMBER (PAULDING)
GAG26830Medicare UPIN
GA0741780007Medicare NSC