Individual provider Active NPI

Thomas A Miller, MD

  • Child & Adolescent Psychiatry Physician
  • Hattiesburg, MS
National Provider Identifier
1083658702
Registry record updated Jun 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
17185 Issued in MS
Practice address
2117 Broadway Drive
Hattiesburg, MS 39402-3210
Phone
(601) 288-8050
Fax
(601) 288-8058
NPI assigned
Jun 15, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 20, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 17185 MS
Child & Adolescent Psychiatry Physician 2084P0804X 17185 MS Primary

Addresses

Primary practice location

2117 Broadway Drive
Hattiesburg, MS 39402-3210

Mailing address

2117 Broadway Drive
Hattiesburg, MS 39402-3210
Phone (601) 288-8050

Other identifiers 3

IdentifierTypeStateIssuer
00124288MedicaidMS
260049973OtherMSMEDICARE RAILRAOD
009967635MedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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
I20080428000534 MS Practitioner - Psychiatry 3072691278 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
22625ALMDPharmacist
17185MSMDChild & Adolescent Psychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Forrest County General Hospital CurrentSince Jan 1, 2008 Accepting new patients
Forrest County General Hospital CurrentSince Jan 1, 2008 Accepting new patients
Forrest County General Hospital Current Accepting new patients

Locations

1 Lincoln Pkwy
Ste 202
Hattiesburg, MS 39402
Phone (601) 288-8050

2117 Broadway Dr
Hattiesburg, MS 39402
Phone (601) 288-8050

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": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750377600000",
    "number": "1083658702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2117 BROADWAY DRIVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394023210",
            "telephone_number": "601-288-8050",
            "fax_number": "601-288-8058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2117 BROADWAY DRIVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394023210",
            "telephone_number": "601-288-8050",
            "fax_number": "601-288-8058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "THOMAS",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2025-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MS",
            "license": "17185",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "MS",
            "license": "17185",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00124288",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILRAOD",
            "identifier": "260049973",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009967635",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hattiesburg, MS

Sources for this page

Verify at the official NPI Registry.