Provider Demographics
NPI:1841789914
Name:MILNER VEIN AND VASCULAR LLC
Entity Type:Organization
Organization Name:MILNER VEIN AND VASCULAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:PATTERSON
Authorized Official - Last Name:MILNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-580-1149
Mailing Address - Street 1:5700 HILLANDALE DR STE 150
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-4120
Mailing Address - Country:US
Mailing Address - Phone:678-580-1149
Mailing Address - Fax:770-557-1347
Practice Address - Street 1:5700 HILLANDALE DR STE 150
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058
Practice Address - Country:US
Practice Address - Phone:678-580-1149
Practice Address - Fax:770-557-1347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-04
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA595622086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA633601408DMedicaid
GA59562OtherGEORGIA LICENSE NUMBER