NPIMap

Organization Active NPI

Jack W Miller

Doing business as Developmental Behavioral Pediatrics

  • Adult Mental Health Clinic/Center
  • Carrollton, GA
National Provider Identifier
1982708368
Registry record updated Feb 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
License
044541 Issued in GA
Legal business name
JACK W MILLER
Doing business as
Developmental Behavioral Pediatrics
Practice address
100 Professional PL
Ste 104
Carrollton, GA 30117-3874
Phone
(770) 830-7039
Fax
(770) 830-7149
NPI assigned
Sep 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2011

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

Authorized official

Name
Dr. Jack W Miller, MDNPI 1275699514
Title
Physician
Phone
(770) 830-7039

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
Adult Mental Health Clinic/Center 261QM0850X 044541 GA Primary

Addresses

Primary practice location

100 Professional PL
Ste 104
Carrollton, GA 30117-3874

Mailing address

100 Professional PL
Ste 104
Carrollton, GA 30117-3874
Phone (770) 830-7039

Other identifiers 1

IdentifierTypeStateIssuer
000767709CMedicaidGA

Other names 1

  • Developmental Behavioral Pediatrics Doing business as

National Provider Directory

National Provider Directory

Locations

100 Professional Pl
Ste 104
Carrollton, GA 30117
Phone (770) 830-7039

Practitioners & affiliated clinicians

Practitioners 3

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": "1157587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296604800000",
    "number": "1982708368",
    "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": {
        "organization_name": "JACK W MILLER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-07",
        "last_updated": "2011-02-02",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "770-830-7039",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "GA",
            "license": "044541",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000767709C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Developmental Behavioral Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carrollton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2011; 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.