Provider Demographics
NPI:1366420507
Name:MILLER, JODI L (DO)
Entity type:Individual
Prefix:DR
First Name:JODI
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5221 PARAMOUNT PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-5490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:155 NASHVILLE COMMONS DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:NC
Practice Address - Zip Code:27856-1823
Practice Address - Country:US
Practice Address - Phone:252-459-7769
Practice Address - Fax:252-459-6539
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9701456207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9701456OtherLICENSE NUMBER
NC8910724Medicaid
NCG61830Medicare UPIN
NC8910724Medicaid