Provider Demographics
NPI:1790886133
Name:MCMILLAN, BEVERLY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:ANN
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 RIVER OAKS DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9500
Mailing Address - Country:US
Mailing Address - Phone:601-936-1400
Mailing Address - Fax:601-936-0671
Practice Address - Street 1:1020 RIVER OAKS DR
Practice Address - Street 2:SUITE 320
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39232-9500
Practice Address - Country:US
Practice Address - Phone:601-936-1400
Practice Address - Fax:601-936-0671
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07159207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07159OtherMEDICAL LICENSE
MS0111272Medicaid
MS07159OtherMEDICAL LICENSE
MSB31172Medicare UPIN