Provider Demographics
NPI:1790374734
Name:MILLER, WILLIAM ELIJAH (PA-C)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ELIJAH
Last Name:MILLER
Suffix:
Gender:M
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 1:121 INTERSTATE BLVD UNIT 2A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-5715
Mailing Address - Country:US
Mailing Address - Phone:864-720-8133
Mailing Address - Fax:
Practice Address - Street 1:121 INTERSTATE BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-5715
Practice Address - Country:US
Practice Address - Phone:864-720-8133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant