Provider Demographics
NPI:1316384415
Name:MCMILLAN, JESSE FRANKLIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:FRANKLIN
Last Name:MCMILLAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3191 MCMILLAN RD
Mailing Address - Street 2:
Mailing Address - City:ENIGMA
Mailing Address - State:GA
Mailing Address - Zip Code:31749-4219
Mailing Address - Country:US
Mailing Address - Phone:229-533-4554
Mailing Address - Fax:
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:
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014585122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist