Individual
MIRAKLE AVERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2611 FOREST DR STE 200, COLUMBIA, SC 29204-2371
(803) 799-3263
Mailing address
2611 FOREST DR STE 200, COLUMBIA, SC 29204-2371
(804) 799-3263
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
6095
SC
Other
Enumeration date
02/16/2024
Last updated
01/15/2026
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