Healthcare Provider Details

I. General information

NPI: 1942164702
Provider Name (Legal Business Name): D'ANDREA MCMILLIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 OAKS LANDING DR
COVINGTON GA
30016-2513
US

IV. Provider business mailing address

80 OAKS LANDING DR
COVINGTON GA
30016-2513
US

V. Phone/Fax

Practice location:
  • Phone: 470-549-0429
  • Fax:
Mailing address:
  • Phone: 470-549-0429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: