NPIMap

Organization Active NPI

Lisa D Miller MD Pediatrics PC

  • Pediatrics Physician
  • Covington, GA
National Provider Identifier
1659352185
Registry record updated Sep 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
013449 Issued in GA
Legal business name
LISA D MILLER MD PEDIATRICS PC
Practice address
4152 Baker St NE
Covington, GA 30014-1404
Phone
(770) 788-1077
Fax
(770) 788-0768
NPI assigned
Nov 10, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2008

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

Authorized official

Name
Dr. Lisa Dawn Miller, MDNPI 1801954458
Title
Owner/Physician
Phone
(770) 788-1077

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 013449 GA Primary

Addresses

Primary practice location

4152 Baker St NE
Covington, GA 30014-1404

Mailing address

4152 Baker St NE
Covington, GA 30014-1404
Phone (770) 788-1077

Other identifiers 3

IdentifierTypeStateIssuer
00618945DMedicaidGA
581934OtherGABCBS
00618945EMedicaidGA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D0992303Lisa D Miller MD Pediatrics4152 Baker Street, Covington, GA 30014Certificate of waiverApr 27, 2028

National Provider Directory

National Provider Directory

Locations

4152 Baker St NE
Covington, GA 30014
Phone (770) 788-1077

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1131580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221523200000",
    "number": "1659352185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4152 BAKER ST NE",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300141404",
            "telephone_number": "770-788-1077",
            "fax_number": "770-788-0768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4152 BAKER ST NE",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300141404",
            "telephone_number": "770-788-1077",
            "fax_number": "770-788-0768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LISA D MILLER MD PEDIATRICS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-10",
        "last_updated": "2008-09-16",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "770-788-1077",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "013449",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00618945D",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "581934",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00618945E",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Covington, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.