Jack W Miller, M.D

Primary specialty

Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X

License

044541 Issued in GA

Practice address

100 Professional PL
Ste 104
Carrollton, GA 30117-3874

Phone

(770) 830-7039

Fax

(770) 830-7149

NPI assigned

Dec 29, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Jack W Miller

  • Adult Mental Health Clinic/Center
  • Carrollton, GA
  • NPI 1982708368
  NPD (past) Authorized official
• Carrollton Pediatric Clinic, P.C.

  • Pediatrics Physician
  • Carrollton, GA
  • NPI 1295834380
  NPD (past)

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770854400000",
    "number": "1275699514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PROFESSIONAL PL",
            "address_2": "STE 104",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173874",
            "telephone_number": "770-830-7039",
            "fax_number": "770-830-7149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PROFESSIONAL PL",
            "address_2": "STE 104",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173874",
            "telephone_number": "770-830-7039",
            "fax_number": "770-830-7149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "JACK",
        "middle_name": "W",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-29",
        "last_updated": "2026-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "GA",
            "license": "044541",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000767709C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard John Mikilitus Jr., MD
• Brittany Miles, LMSW
• Jill B Miles, LCSW
• Rodger A Miles Jr., REGISTERD PHARMACIST
• Randi Danielle Miley
• Lauren Elizabeth Miller
• Sydney Danielle Miller
• John Michael Mills, DMD
• Mind Body Soul Counseling Services, LLC
• Keri L Minton, PA

• Developmental - Behavioral Pediatrics Physician in Carrollton, GA
• Providers in Carrollton, GA by specialty
• Developmental - Behavioral Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2026; 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.