Provider Demographics
NPI:1578308375
Name:MILLER, LAURA MICHELLE (RN)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MICHELLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3255 CUSTER LAKE DR NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-1125
Mailing Address - Country:US
Mailing Address - Phone:470-304-6709
Mailing Address - Fax:
Practice Address - Street 1:218 STONEWALL ST
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3628
Practice Address - Country:US
Practice Address - Phone:678-719-0177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA283003163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)