Individual
DR. MIRANDA COLLETTA HORTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
620 SINGLETON RIDGE RD, CONWAY, SC 29526-9154
(843) 347-7300
(843) 347-8459
Mailing address
300 SINGLETON RIDGE RD, ATTN PNS CREDENTIALING, CONWAY, SC 29526-9142
(843) 234-6946
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
86199
GA
207Y00000X
Otolaryngology Physician
Primary
86510
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
865102
—
SC
Enumeration date
04/01/2015
Last updated
09/02/2022
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