Provider Demographics
NPI:1316589500
Name:MILLENIAL MEDICAL CLINIC
Entity Type:Organization
Organization Name:MILLENIAL MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:MADISON
Authorized Official - Middle Name:N
Authorized Official - Last Name:DELK
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:615-895-6900
Mailing Address - Street 1:710 MEMORIAL BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-2703
Mailing Address - Country:US
Mailing Address - Phone:615-895-6900
Mailing Address - Fax:615-895-6912
Practice Address - Street 1:710 MEMORIAL BLVD STE 110
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2703
Practice Address - Country:US
Practice Address - Phone:615-895-6900
Practice Address - Fax:615-895-6912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty