Provider Demographics
NPI:1689756942
Name:MILLER, EMILY J (PA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:J
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:115 N SUMTER ST
Mailing Address - Street 2:STE. 115
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4972
Mailing Address - Country:US
Mailing Address - Phone:803-436-5974
Mailing Address - Fax:803-436-5975
Practice Address - Street 1:115 N SUMTER ST
Practice Address - Street 2:STE. 115
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4972
Practice Address - Country:US
Practice Address - Phone:803-436-5974
Practice Address - Fax:803-436-5975
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCA901207R00000X
SC901363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC46599Medicaid
SC46599Medicaid