Provider Demographics
NPI:1568750636
Name:MCMILLAN, LAUREN SHAW (ANP-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:SHAW
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 GILLIKIN ST
Mailing Address - Street 2:
Mailing Address - City:TWIN CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30471-3989
Mailing Address - Country:US
Mailing Address - Phone:478-763-3036
Mailing Address - Fax:478-763-3787
Practice Address - Street 1:115 GILLIKIN ST
Practice Address - Street 2:
Practice Address - City:TWIN CITY
Practice Address - State:GA
Practice Address - Zip Code:30471-3989
Practice Address - Country:US
Practice Address - Phone:478-763-3036
Practice Address - Fax:478-763-3787
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN184339363L00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1887Medicaid
GA003111869AMedicaid
GAP00962297OtherRAILROAD MEDICARE
GA624907OtherWELLCARE
GA624907OtherWELLCARE