Provider Demographics
NPI:1467778829
Name:MCMILLAN, AMANDA LAUREL (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:LAUREL
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 RIDGEWOOD DR NE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1031
Mailing Address - Country:US
Mailing Address - Phone:404-727-5157
Mailing Address - Fax:
Practice Address - Street 1:2004 RIDGEWOOD DR NE
Practice Address - Street 2:SUITE 216
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1031
Practice Address - Country:US
Practice Address - Phone:404-727-5157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-10
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA45922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program