Individual
CHARLES D. MCMILLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
993-C JOHNSON FERRY ROAD, SUITE 300, ATLANTA, GA 30342
(678) 574-0943
(678) 574-0943
Mailing address
200 MANSELL COURT, ATTN: CREDENTIALING DEPT, SUITE 105, ROSWELL, GA 30076-4848
(770) 645-9181
(770) 645-8455
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
40482
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1821086596
BLUE CROSS BLUE SHIELD
GA
01
—
20-02624
UNITED HEALTHCARE
GA
01
—
9975585
UNIVERSAL HEALTHCARE
GA
Enumeration date
10/07/2005
Last updated
04/20/2008
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