Provider Demographics
NPI:1912039934
Name:MCMILLAN, CLEOPHAS LOUIS (MED)
Entity Type:Individual
Prefix:MR
First Name:CLEOPHAS
Middle Name:LOUIS
Last Name:MCMILLAN
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 MCLEOD RD
Mailing Address - Street 2:
Mailing Address - City:RED SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28377-1952
Mailing Address - Country:US
Mailing Address - Phone:910-843-5464
Mailing Address - Fax:
Practice Address - Street 1:404 MCLEOD RD
Practice Address - Street 2:
Practice Address - City:RED SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28377-1952
Practice Address - Country:US
Practice Address - Phone:910-843-5464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6211235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist