Provider Demographics
NPI:1689270464
Name:DR. ANGELA MILAM & ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:DR. ANGELA MILAM & ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & CHIEF MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:901-827-1008
Mailing Address - Street 1:130 COLEGROVE ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2013
Mailing Address - Country:US
Mailing Address - Phone:901-827-1008
Mailing Address - Fax:
Practice Address - Street 1:2760 N GERMANTOWN PKWY STE 109
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-8154
Practice Address - Country:US
Practice Address - Phone:901-827-1008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty