Provider Demographics
NPI:1821086596
Name:MCMILLON, CHARLES D (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:D
Last Name:MCMILLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:200 MANSELL COURT
Mailing Address - Street 2:ATTN: CREDENTIALING DEPT, SUITE 105
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4848
Mailing Address - Country:US
Mailing Address - Phone:770-645-9181
Mailing Address - Fax:770-645-8455
Practice Address - Street 1:993-C JOHNSON FERRY ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:678-574-0943
Practice Address - Fax:678-574-0943
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2008-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA40482207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA9975585OtherUNIVERSAL HEALTHCARE
GA1821086596OtherBLUE CROSS BLUE SHIELD
GA20-02624OtherUNITED HEALTHCARE
GA1821086596OtherBLUE CROSS BLUE SHIELD
GA1821086596OtherBLUE CROSS BLUE SHIELD
GA20-02624OtherUNITED HEALTHCARE