Provider Demographics
NPI:1518162940
Name:MCMILLION, LAWRENCE WAYNE (DO)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:WAYNE
Last Name:MCMILLION
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-939-7711
Mailing Address - Fax:765-939-1841
Practice Address - Street 1:1050 REID PKWY STE 210
Practice Address - Street 2:REID NEUROLOGY ASSOCIATES
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1160
Practice Address - Country:US
Practice Address - Phone:765-939-7711
Practice Address - Fax:765-939-1841
Is Sole Proprietor?:No
Enumeration Date:2007-06-16
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003265A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201339470Medicaid
IN000000983438OtherANTHEM
IN000000983438OtherANTHEM