Provider Demographics
NPI:1013901289
Name:MCMILLIN, RODNEY MOORE (MD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:MOORE
Last Name:MCMILLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 N ROANE ST
Mailing Address - Street 2:
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-2057
Mailing Address - Country:US
Mailing Address - Phone:865-882-3745
Mailing Address - Fax:865-882-6072
Practice Address - Street 1:408 N ROANE ST
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-2057
Practice Address - Country:US
Practice Address - Phone:865-882-3745
Practice Address - Fax:865-882-6072
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11665207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3189752OtherRAILROAD MEDICARE
TNQ066115Medicaid
TN3189752Medicaid
TN3189752Medicaid
TN3189752Medicare PIN