Provider Demographics
NPI:1770547093
Name:MILES, WILLIAM L
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:L
Last Name:MILES
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:L
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2719 MIDDLEBURG DRIVE
Mailing Address - Street 2:STE 202
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204
Mailing Address - Country:US
Mailing Address - Phone:803-254-1194
Mailing Address - Fax:803-254-1197
Practice Address - Street 1:2719 MIDDLEBURG DRIVE
Practice Address - Street 2:STE 202
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204
Practice Address - Country:US
Practice Address - Phone:803-254-1194
Practice Address - Fax:803-254-1197
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC09064207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC090644Medicaid
SCD176760281Medicare ID - Type Unspecified
SC090644Medicaid