Provider Demographics
NPI:1205254190
Name:MCMILLIN, JAKE C (MD)
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:C
Last Name:MCMILLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1124 E WEISGARBER RD STE 104
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2686
Mailing Address - Country:US
Mailing Address - Phone:865-584-2127
Mailing Address - Fax:865-392-5536
Practice Address - Street 1:10841 HARDIN VALLEY RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-1410
Practice Address - Country:US
Practice Address - Phone:865-584-0905
Practice Address - Fax:865-584-3892
Is Sole Proprietor?:No
Enumeration Date:2014-03-29
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN58987207WX0120X, 207W00000X
TXR6836207WX0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist