Healthcare Provider Details

I. General information

NPI: 1891615688
Provider Name (Legal Business Name): ANTOINETTE RISHELLE MILLER-PONDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2228 LEE ST
BRUNSWICK GA
31520-5633
US

IV. Provider business mailing address

2228 LEE ST
BRUNSWICK GA
31520-5633
US

V. Phone/Fax

Practice location:
  • Phone: 912-254-8137
  • Fax:
Mailing address:
  • Phone: 912-254-8137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: