Provider Demographics
NPI:1518417641
Name:MILLIKAN RANIC, LARA (ACNPC-AG)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:MILLIKAN RANIC
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:LARA
Other - Middle Name:LYNN
Other - Last Name:MILLIKAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:230 PIONEER TRAIL
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30121
Mailing Address - Country:US
Mailing Address - Phone:770-841-2099
Mailing Address - Fax:
Practice Address - Street 1:330 TURNER MCCALL BLVD SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165
Practice Address - Country:US
Practice Address - Phone:706-509-3430
Practice Address - Fax:706-291-2147
Is Sole Proprietor?:No
Enumeration Date:2016-10-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN203833363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner