Provider Demographics
NPI:1669751533
Name:MILLER, AMY RUSHTON
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:RUSHTON
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 1:2728 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29070-9744
Mailing Address - Country:US
Mailing Address - Phone:803-673-4731
Mailing Address - Fax:
Practice Address - Street 1:2414 BULL ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-1906
Practice Address - Country:US
Practice Address - Phone:803-898-8581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program