Active NPI
Stephen R Miller, PT
- Physical Therapist
- Douglas, GA
National Provider Identifier
1093737835
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT001828
- Practice address
- 1150 West Ward Street Extension
Magnolia Place B-1
Douglas, GA 31533-1902 - Phone
- (912) 384-4813
- Fax
- (912) 383-9090
- NPI assigned
- Jul 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT001828 | GA | Primary |
Addresses
Primary practice location
1150 West Ward Street Extension
Magnolia Place B-1
Douglas, GA 31533-1902
Mailing address
1150 West Ward Street Extension
Magnolia Place B-1
Douglas, GA 31533-1902
Phone (912) 384-4813
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 52775003 | Other | GA | BLUE CROSS BLUE SHIELD OF |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT001828 | GA | MD | Physical Therapist |
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": "1184630400000",
"number": "1093737835",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1150 WEST WARD STREET EXTENSION",
"address_2": "MAGNOLIA PLACE B-1",
"city": "DOUGLAS",
"state": "GA",
"postal_code": "315331902",
"telephone_number": "912-384-4813",
"fax_number": "912-383-9090"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1150 WEST WARD STREET EXTENSION",
"address_2": "MAGNOLIA PLACE B-1",
"city": "DOUGLAS",
"state": "GA",
"postal_code": "315331902",
"telephone_number": "912-384-4813",
"fax_number": "912-383-9090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "STEPHEN",
"middle_name": "R",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-24",
"last_updated": "2007-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "GA",
"license": "PT001828",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD OF",
"identifier": "52775003",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Douglas, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.