Basic Information
| Provider Information | |||||||||
| NPI: | 1578589339 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER MURRAY | ||||||||
| FirstName: | CECILE | ||||||||
| MiddleName: | MAUGE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1624 MAIN STREET | ||||||||
| Address2: | AGAPE SENIOR PRIMARY CARE, INC | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292012818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037262350 | ||||||||
| FaxNumber: | 8037539102 | ||||||||
| Practice Location | |||||||||
| Address1: | 1317 EBENEZER ROAD | ||||||||
| Address2: | |||||||||
| City: | ROCK HILL | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8035229175 | ||||||||
| FaxNumber: | 8032078207 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2006 | ||||||||
| LastUpdateDate: | 05/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 36251 | SC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 231489 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 2008-00915 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02700470 | 05 | NY | MEDICAID | 5910965 | 05 | NC | MEDICAID | P00717905 | 01 | NC | RAILROAD MEDICARE | OTHER |