Provider Demographics
NPI:1629102694
Name:MCMILLAN, KERRI FLOYD (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KERRI
Middle Name:FLOYD
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SHORT ST
Mailing Address - Street 2:
Mailing Address - City:SYLVESTER
Mailing Address - State:GA
Mailing Address - Zip Code:31791-7236
Mailing Address - Country:US
Mailing Address - Phone:229-776-4340
Mailing Address - Fax:
Practice Address - Street 1:103 SHORT ST
Practice Address - Street 2:
Practice Address - City:SYLVESTER
Practice Address - State:GA
Practice Address - Zip Code:31791-7236
Practice Address - Country:US
Practice Address - Phone:229-776-4340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004156235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00966567AMedicaid