Individual
RUSSELL COLTON MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2755 S HIGHWAY 14 STE 1200L, GREER, SC 29650-4902
(864) 849-9150
(864) 849-9334
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4772
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6149PA
—
SC
01
—
SCP2527628
MEDICARE PIN
SC
Enumeration date
05/21/2020
Last updated
01/03/2024
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