Provider Demographics
NPI:1134281793
Name:MILLER, JANICE SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:SUSAN
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-7487
Mailing Address - Fax:843-777-7102
Practice Address - Street 1:1040 MARLBORO WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512-2494
Practice Address - Country:US
Practice Address - Phone:843-479-5890
Practice Address - Fax:843-479-3524
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC37563207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIG36028Medicare UPIN
RI007009814Medicare ID - Type UnspecifiedMEDICARE