Provider Information for 1356816888
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Mrs. LISA SHEA MILLER
Sex: Female
NPI: 1356816888
Last Updated: 2024-02-09
Certification Date: 2024-02-09
Certification Date: 2024-02-09
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1356816888 | ||||||||
| Enumeration Date | 2018-10-11 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 4741 GARDENIA TRCE MOUNT OLIVE, AL 35117-3461 United States Phone: 205-602-9335 | Fax: | ||||||||
| Primary Practice Address | 1501 DECATUR HWY STE 101 GARDENDALE, AL 35071-3857 United States Phone: 205-644-1166 | Fax:800-514-9302 | ||||||||
| Secondary Practice Address(es) | 4741 GARDENIA TRCE 9064 HELENA RD | ||||||||
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