Provider Demographics
NPI:1356053086
Name:MACMILLZ MOBILE MEDI ASSESSMENTS LLC
Entity type:Organization
Organization Name:MACMILLZ MOBILE MEDI ASSESSMENTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER (OWNER)
Authorized Official - Prefix:
Authorized Official - First Name:TORIE
Authorized Official - Middle Name:LAVERNE
Authorized Official - Last Name:MCMILLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:336-478-5924
Mailing Address - Street 1:30 SALEM RDG
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-4184
Mailing Address - Country:US
Mailing Address - Phone:770-501-6977
Mailing Address - Fax:770-268-6648
Practice Address - Street 1:30 SALEM RDG
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-4184
Practice Address - Country:US
Practice Address - Phone:770-501-6977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health