NPIMap

Organization Active NPI

George M Miller Jr MD PC

  • Surgery Physician
  • Grenada, MS
National Provider Identifier
1093828048
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
17647 Issued in MS
Legal business name
GEORGE M MILLER JR MD PC
Practice address
1300 Sunset Dr
Suite R
Grenada, MS 38901-4086
Phone
(662) 226-7540
Fax
(662) 226-6268
NPI assigned
Aug 16, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. George M Miller Jr., MD
Title
President
Phone
(662) 226-7540

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X 17647 MS Primary

Addresses

Primary practice location

1300 Sunset Dr
Suite R
Grenada, MS 38901-4086

Mailing address

1300 Sunset Dr
Suite R
Grenada, MS 38901-4086
Phone (662) 226-7540

Other identifiers 1

IdentifierTypeStateIssuer
09016121MedicaidMS

National Provider Directory

National Provider Directory
Tax ID family
Grenada Lake Medical Ce3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093828048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 SUNSET DR",
            "address_2": "SUITE R",
            "city": "GRENADA",
            "state": "MS",
            "postal_code": "389014086",
            "telephone_number": "662-226-7540",
            "fax_number": "662-226-6268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 SUNSET DR",
            "address_2": "SUITE R",
            "city": "GRENADA",
            "state": "MS",
            "postal_code": "389014086",
            "telephone_number": "662-226-7540",
            "fax_number": "662-226-6268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGE M MILLER JR MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "662-226-7540",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "MS",
            "license": "17647",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09016121",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grenada, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.