Provider Demographics
NPI:1558950030
Name:OVERHOLSER, MIRIAM ISKANDAR (PA-C)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:ISKANDAR
Last Name:OVERHOLSER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:ISKANDAR
Other - Last Name:GUIRGIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1031 FIDDLEHEAD WAY
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-3812
Mailing Address - Country:US
Mailing Address - Phone:843-446-5221
Mailing Address - Fax:
Practice Address - Street 1:1500 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-3569
Practice Address - Country:US
Practice Address - Phone:843-438-8470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3762363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant