MEDICARE: AMY RUSHTON MILLER

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1669751533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY RUSHTON MILLER

Provider Business Mailing Address
First Line	:	2728 FAIRVIEW RD
Second Line	:
City	:	LEESVILLE
State	:	SC
Zip	:	29070-9744
Country	:	US
Telephone Number	:	803-673-4731
Fax Number	:

Provider Business Practice Location Address
First Line	:	2414 BULL ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-1906
Country	:	US
Telephone Number	:	803-898-8581
Fax Number	:

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

Provider Enumeration Date	:	08/10/2011
Last Update Date	:	08/10/2011

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