Provider Demographics
NPI:1629090816
Name:MCMILLIAN, JAMES RUEL (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:RUEL
Last Name:MCMILLIAN
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 1:420 E 2ND AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3224
Mailing Address - Country:US
Mailing Address - Phone:706-509-3000
Mailing Address - Fax:706-509-4608
Practice Address - Street 1:420 E 2ND AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-3224
Practice Address - Country:US
Practice Address - Phone:706-509-3000
Practice Address - Fax:706-509-4608
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010237208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000012823CMedicaid
GAN/AMedicare ID - Type UnspecifiedMEDICARE
GA000012823CMedicaid