Individual provider Active NPI

Stephen Miller, MD

  • Pediatric Sports Medicine Physician
  • Atlanta, GA
National Provider Identifier
1063434488
Registry record updated Jun 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Sports Medicine PhysicianTaxonomy code 2080S0010X
License
87084 Issued in GA
Practice address
5445 Meridian Mark Rd Ste 250
Atlanta, GA 30342-4767
Phone
(404) 255-1933
Fax
(404) 256-7924
NPI assigned
Jul 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Sports Medicine Physician 2080S0010X 87084 GA Primary

Addresses

Primary practice location

5445 Meridian Mark Rd Ste 250
Atlanta, GA 30342-4767

Mailing address

5445 Meridian Mark Rd Ste 250
Atlanta, GA 30342-4767
Phone (404) 255-1933

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address choa@choa.gadirect.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101027000757 VA Practitioner - Pediatric MedicinePractitioner - Sports Medicine 8123212891 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
87084GAMDPediatric Sports Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Childrens Specialty Group PLLC Pediatrics CurrentSince Jul 11, 2010 Accepting new patients
Children'S Orthopaedics of Atlanta P.C. CurrentSince Jun 27, 2021 Accepting new patients
Choa Hospital Based, LLC Pediatrics Past Accepting new patients

Locations

5445 Meridian Mark Rd
Ste 250
Sandy Springs, GA 30342

601 Childrens Ln
Norfolk, VA 23507
Phone (757) 668-7272

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654473600000",
    "number": "1063434488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5445 MERIDIAN MARK RD STE 250",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303424767",
            "telephone_number": "404-255-1933",
            "fax_number": "404-256-7924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5445 MERIDIAN MARK RD STE 250",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303424767",
            "telephone_number": "404-255-1933",
            "fax_number": "404-256-7924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "STEPHEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2022-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080S0010X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Sports Medicine",
            "state": "GA",
            "license": "87084",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "choa@choa.gadirect.net",
            "affiliation": "N",
            "address_1": "5445 Meridian Mark Rd Ste 250",
            "city": "Atlanta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "303424767",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.