Provider Demographics
NPI:1750466769
Name:MILLER, RONALD G (DPM)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:G
Last Name:MILLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30129
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-0129
Mailing Address - Country:US
Mailing Address - Phone:912-272-2281
Mailing Address - Fax:
Practice Address - Street 1:308 WINCHESTER DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410-4409
Practice Address - Country:US
Practice Address - Phone:912-272-2281
Practice Address - Fax:912-898-1541
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA342213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA$$$$$$$$$OtherTRICARE
GA$$$$$$$$$OtherTRICARE
GA$$$$$$$$$AMedicare PIN