Individual ProviderJerry MillerFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address105 W Stone Dr, Ste 3a, Kingsport, TN 37660-3256(423) 392-6200(423) 857-2066PECOS EnrollmentBased on the most recent information from CMS, provider Jerry Miller does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 4:18 PM.Profile DetailsProvider ID1053315697Provider TypeIndividualFull NameMiller, JerryCredentialMDGenderMaleSole ProprietorNoEnumeration Date6/10/2005Last Updated9/22/2009Contact InformationPractice LocationPractice Address105 W Stone Dr, Ste 3a, Kingsport, TN 37660-3256Phone(423) 392-6200FaxUnlisted FaxMailing LocationMailing AddressPO Box 9, Kingsport, TN 37662-0009Phone(423) 857-2066Fax(423) 857-2070Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseMD 5663TennesseeCode207Q00000XDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicense0101017451VirginiaProvider IdentifiersIDDescriptionIssuerID3173496DescriptionMedicaidIssuerUnlistedTennessee