Provider Demographics
NPI:1154074698
Name:JESSE F. MCMILLAN DMD LLC
Entity Type:Organization
Organization Name:JESSE F. MCMILLAN DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:229-896-4166
Mailing Address - Street 1:130 S PARRISH AVE
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:GA
Mailing Address - Zip Code:31620-2642
Mailing Address - Country:US
Mailing Address - Phone:229-896-4166
Mailing Address - Fax:229-896-4731
Practice Address - Street 1:130 S PARRISH AVE
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:GA
Practice Address - Zip Code:31620-2642
Practice Address - Country:US
Practice Address - Phone:229-896-4166
Practice Address - Fax:229-896-4731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental