Provider Demographics
NPI:1871359133
Name:MILES, JOHN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MILES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:852 BROWN THRASHER RD
Mailing Address - Street 2:
Mailing Address - City:MERSHON
Mailing Address - State:GA
Mailing Address - Zip Code:31551-2214
Mailing Address - Country:US
Mailing Address - Phone:912-288-4402
Mailing Address - Fax:
Practice Address - Street 1:852 BROWN THRASHER RD
Practice Address - Street 2:
Practice Address - City:MERSHON
Practice Address - State:GA
Practice Address - Zip Code:31551-2214
Practice Address - Country:US
Practice Address - Phone:912-288-4402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor