Provider Demographics
NPI:1578782918
Name:MILL CREEK CENTER P.C.
Entity Type:Organization
Organization Name:MILL CREEK CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RODDY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:INGRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-673-7889
Mailing Address - Street 1:2971 HURRICANE ROAD
Mailing Address - Street 2:
Mailing Address - City:ROCKY FACE
Mailing Address - State:GA
Mailing Address - Zip Code:30740-8716
Mailing Address - Country:US
Mailing Address - Phone:706-673-7889
Mailing Address - Fax:706-673-3628
Practice Address - Street 1:2971 HURRICANE RD
Practice Address - Street 2:
Practice Address - City:ROCKY FACE
Practice Address - State:GA
Practice Address - Zip Code:30740-8716
Practice Address - Country:US
Practice Address - Phone:706-673-7889
Practice Address - Fax:706-673-3628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Not Answered2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Multi-Specialty