Provider Demographics
NPI:1215377908
Name:MILLER, LAURA SOUTHERN (APRN)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:SOUTHERN
Last Name:MILLER
Suffix:
Gender:F
Credentials:APRN
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 1039
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-1039
Mailing Address - Country:US
Mailing Address - Phone:828-631-3181
Mailing Address - Fax:828-631-6113
Practice Address - Street 1:90 E MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-3030
Practice Address - Country:US
Practice Address - Phone:828-631-3181
Practice Address - Fax:828-631-6113
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009155363L00000X
GARN182120363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN182120OtherGEORGIA LICENSE #