Provider Demographics
NPI:1083191654
Name:MCMILLAN, MELANIE NOELLE (MSN, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:NOELLE
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4155 BRASHER DR NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-2959
Mailing Address - Country:US
Mailing Address - Phone:202-445-1018
Mailing Address - Fax:
Practice Address - Street 1:2260 NORTHLAKE PKWY STE 211
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4006
Practice Address - Country:US
Practice Address - Phone:770-491-1344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN211921363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily