Provider Demographics
NPI:1609693423
Name:MILLER, BRYAN LEE
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:LEE
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:PO BOX 701
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35502-0701
Mailing Address - Country:US
Mailing Address - Phone:205-582-4345
Mailing Address - Fax:205-582-4345
Practice Address - Street 1:200 18TH ST W
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-5363
Practice Address - Country:US
Practice Address - Phone:205-582-4345
Practice Address - Fax:205-582-4345
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6285G104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker