NPI 1013772391

Mirakle Avery

Practitioner Physician Assistant Columbia, SC

Practice location

Address: 2611 Forest Dr STE 200, Columbia, SC 29204-2371
Phone: (803) 799-3263

Registered specialties

Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363A00000X Licence 6095 (SC)

Other Physician Assistant providers in South Carolina →

Registry record

NPI: 1013772391
Entity type: Individual
Sex (as registered): Female
NPI issued: 16 Feb 2024
Record last updated: 15 Jan 2026

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.