Mirakle Avery

NPI #1013772391 in Columbia, South Carolina

Provider Information

NPI Number: 1013772391
Entity Type: Individual
Name: Mirakle Avery
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Enumeration Date: Feb 16, 2024
Last Updated: Jan 15, 2026

Practice Location

Address: 2611 FOREST DR STE 200
City: Columbia
State: South Carolina
ZIP Code: 29204-2371
Phone: (803) 799-3263

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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