Provider Demographics
NPI:1689958647
Name:MILES, SOLA E (MHS, PA-C)
Entity Type:Individual
Prefix:
First Name:SOLA
Middle Name:E
Last Name:MILES
Suffix:
Gender:F
Credentials:MHS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 WAIT AVE
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-2725
Mailing Address - Country:US
Mailing Address - Phone:919-883-2108
Mailing Address - Fax:919-882-9643
Practice Address - Street 1:401 WAIT AVE
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587
Practice Address - Country:US
Practice Address - Phone:919-883-2108
Practice Address - Fax:919-882-9643
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-03067363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8102710Medicaid
NCNC9090AMedicare UPIN