Provider Demographics
NPI:1801860564
Name:MCMILLAN, VICKIE (CNP)
Entity Type:Individual
Prefix:MS
First Name:VICKIE
Middle Name:
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 N MEDICAL PKWY
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-7031
Mailing Address - Country:US
Mailing Address - Phone:770-592-3000
Mailing Address - Fax:770-592-3012
Practice Address - Street 1:145 N MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-7031
Practice Address - Country:US
Practice Address - Phone:770-592-3000
Practice Address - Fax:770-592-3012
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN134308363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner