Provider Demographics
NPI:1336113232
Name:MILLER, REBECCA HAMILTON (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:HAMILTON
Last Name:MILLER
Suffix:
Gender:F
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 1:9213A UNIVERSITY BLVD
Mailing Address - Street 2:TRIDENT EXECUTIVE VILLAGE
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406
Mailing Address - Country:US
Mailing Address - Phone:843-572-7123
Mailing Address - Fax:843-572-7350
Practice Address - Street 1:9213A UNIVERSITY BLVD
Practice Address - Street 2:TRIDENT EXECUTIVE VILLAGE
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406
Practice Address - Country:US
Practice Address - Phone:843-572-7123
Practice Address - Fax:843-572-7350
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCA243363A00000X
SC243363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC243OtherLICENSE
SCQ26776Medicare ID - Type Unspecified
SC243OtherLICENSE