Provider Demographics
NPI:1679129829
Name:MCMILLIN, AMBER GODSEY
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:GODSEY
Last Name:MCMILLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 VOLUNTEER PARKWAY
Mailing Address - Street 2:SUITE C1
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620
Mailing Address - Country:US
Mailing Address - Phone:423-989-3223
Mailing Address - Fax:
Practice Address - Street 1:1159 VOLUNTEER PARKWAY
Practice Address - Street 2:SUITE C1
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620
Practice Address - Country:US
Practice Address - Phone:423-989-3223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000026221207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNAPN0000026221OtherTENNESSEE APRN LICENSE NUMBER