MEDICARE: DR. EDDRINA RICKIA MILLER PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	1714	SC

General Provider Information

NPI Number	:	1205811270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDDRINA RICKIA MILLER PHD

Provider Business Mailing Address
First Line	:	6439 GARNERS FERRY RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29209-1639
Country	:	US
Telephone Number	:	910-916-1835
Fax Number	:

Provider Business Practice Location Address
First Line	:	6439 GARNERS FERRY RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29209-1638
Country	:	US
Telephone Number	:	910-916-1835
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	03/14/2022

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