Individual
JONATHAN KEVIN MILLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 MEDICAL PARK DR, CHESTER, SC 29706-9769
(803) 581-3151
Mailing address
PO BOX 603898, CHARLOTTE, NC 28260-3898
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
011233708
NC
207P00000X
Emergency Medicine Physician
Primary
85495
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89135FU
—
NC
05
—
N00840
—
SC
Enumeration date
08/09/2006
Last updated
04/21/2021
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