Provider Demographics
NPI:1437330412
Name:MCILWAIN, MARGARET ANN (FNP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:ANN
Last Name:MCILWAIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1857 W MCINTOSH RD
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-1705
Mailing Address - Country:US
Mailing Address - Phone:770-710-6734
Mailing Address - Fax:
Practice Address - Street 1:1857 W MCINTOSH RD
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-1705
Practice Address - Country:US
Practice Address - Phone:770-710-6734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR877985363LF0000X
GARN 123403363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00455877OtherRAILROAD MEDICARE
MS03870794Medicaid
MSP00455877OtherRAILROAD MEDICARE