Provider Demographics
NPI:1881418150
Name:MCMILLIAN, JAMES (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:MCMILLIAN
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 IZZEA ST
Mailing Address - Street 2:
Mailing Address - City:BUZZARD BAY
Mailing Address - State:MA
Mailing Address - Zip Code:02542
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:168 IZZEA ST
Practice Address - Street 2:
Practice Address - City:BUZZARD BAY
Practice Address - State:MA
Practice Address - Zip Code:02542
Practice Address - Country:US
Practice Address - Phone:508-968-7162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA100456363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant