Provider Demographics
NPI:1518113679
Name:MILLIGAN, JOHN LESLIE (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LESLIE
Last Name:MILLIGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 CLEVELAND ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-9716
Mailing Address - Country:US
Mailing Address - Phone:931-787-1940
Mailing Address - Fax:931-787-1943
Practice Address - Street 1:49 CLEVELAND ST
Practice Address - Street 2:SUITE 310
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-9716
Practice Address - Country:US
Practice Address - Phone:931-787-1940
Practice Address - Fax:931-787-1943
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000046056208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery