Provider Demographics
NPI:1205832995
Name:MILLER, DAVID T (GNP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:T
Last Name:MILLER
Suffix:
Gender:M
Credentials:GNP
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 84068
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-0002
Mailing Address - Country:US
Mailing Address - Phone:803-699-9073
Mailing Address - Fax:866-527-0937
Practice Address - Street 1:335 PLEASANT POINT DR
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29907-1164
Practice Address - Country:US
Practice Address - Phone:803-699-9073
Practice Address - Fax:866-527-0937
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR90136363L00000X
SCG90136363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0834Medicaid
SCNP0834Medicaid
SCS33939Medicare UPIN