Healthcare Provider Details

I. General information

NPI: 1093743742
Provider Name (Legal Business Name): MILLICENT M. BYRD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 CLAIRMONT RD 170-C
DECATUR GA
30033-4004
US

IV. Provider business mailing address

3283 JACK RUSSELL RUN
LILBURN GA
30047-7518
US

V. Phone/Fax

Practice location:
  • Phone: 404-321-6111
  • Fax: 404-235-3038
Mailing address:
  • Phone: 404-321-6111
  • Fax: 404-235-3038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN 144078
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: