Provider Demographics
NPI:1700223781
Name:DRIVER, LEAH MILLER (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:MILLER
Last Name:DRIVER
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 WEST TER
Mailing Address - Street 2:
Mailing Address - City:EDGEFIELD
Mailing Address - State:SC
Mailing Address - Zip Code:29824-1168
Mailing Address - Country:US
Mailing Address - Phone:803-206-1492
Mailing Address - Fax:
Practice Address - Street 1:214 WEST TER
Practice Address - Street 2:
Practice Address - City:EDGEFIELD
Practice Address - State:SC
Practice Address - Zip Code:29824-1168
Practice Address - Country:US
Practice Address - Phone:803-206-1492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC535133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered