Provider Demographics
NPI:1740330794
Name:MCMILLION, MARY J (CDCES)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:MCMILLION
Suffix:
Gender:F
Credentials:CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1680
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25717-1680
Mailing Address - Country:US
Mailing Address - Phone:304-697-1396
Mailing Address - Fax:304-697-2086
Practice Address - Street 1:408 ALEXANDER STREET
Practice Address - Street 2:
Practice Address - City:CEDAR GROVE
Practice Address - State:WV
Practice Address - Zip Code:25039
Practice Address - Country:US
Practice Address - Phone:304-595-1770
Practice Address - Fax:304-595-3298
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV235133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV070946Medicare ID - Type Unspecified