Provider Demographics
NPI:1467935288
Name:MILLER, GEORGIA (PA-C)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 WILSON HALL RD
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1804
Mailing Address - Country:US
Mailing Address - Phone:803-905-3555
Mailing Address - Fax:803-905-3570
Practice Address - Street 1:1285 WILSON HALL RD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1804
Practice Address - Country:US
Practice Address - Phone:803-905-3555
Practice Address - Fax:803-905-3570
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC3058363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant