Provider Demographics
NPI:1013210335
Name:MILLAN, ANDREW
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:MILLAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 BROAD ST
Mailing Address - Street 2:SUITE# 202
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37408-3027
Mailing Address - Country:US
Mailing Address - Phone:423-648-1609
Mailing Address - Fax:423-648-1610
Practice Address - Street 1:3001 BROAD ST
Practice Address - Street 2:SUITE# 202
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37408-3027
Practice Address - Country:US
Practice Address - Phone:423-648-1609
Practice Address - Fax:423-648-1610
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL000000007605253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care