Healthcare Provider Details

I. General information

NPI: 1730340407
Provider Name (Legal Business Name): MCMILLION MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 WHITESPORT DR SW STE 201
HUNTSVILLE AL
35801-6429
US

IV. Provider business mailing address

400 WHITESPORT DR SW STE 201
HUNTSVILLE AL
35801-6429
US

V. Phone/Fax

Practice location:
  • Phone: 256-489-3836
  • Fax: 256-489-3940
Mailing address:
  • Phone: 256-489-3836
  • Fax: 256-489-3940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number27651
License Number StateAL

VIII. Authorized Official

Name: DAVID A. MCMILLION
Title or Position: PRESIDENT
Credential: MD
Phone: 256-489-3836