Provider Demographics
NPI:1962024422
Name:MILLER, MONICA
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1195
Mailing Address - Street 2:
Mailing Address - City:BARNWELL
Mailing Address - State:SC
Mailing Address - Zip Code:29812-1195
Mailing Address - Country:US
Mailing Address - Phone:803-645-7122
Mailing Address - Fax:
Practice Address - Street 1:1313 HUNTER DR
Practice Address - Street 2:
Practice Address - City:BARNWELL
Practice Address - State:SC
Practice Address - Zip Code:29812-6773
Practice Address - Country:US
Practice Address - Phone:803-645-7122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X, 171M00000X, 172A00000X, 251J00000X, 374U00000X, 251E00000X
SC9982306376K00000X
GACN0030036744376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No172A00000XOther Service ProvidersDriver
No251J00000XAgenciesNursing Care
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherNONE TO REPORT