Individual
TRACEY TANETTE MILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
120 JOHN MARK DIAL DR STE B, COLUMBIA, SC 29209-9482
(803) 210-5368
Mailing address
465 DUKES HILL RD, COLUMBIA, SC 29203-9070
(803) 210-5368
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
92-1923288
—
SC
Enumeration date
01/30/2023
Last updated
02/07/2023
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