Healthcare Provider Details

I. General information

NPI: 1669207601
Provider Name (Legal Business Name): LAUREN MICHELE MCMILLAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 18TH ST E
TIFTON GA
31794-3648
US

IV. Provider business mailing address

1308 FOREST WAY
NASHVILLE GA
31639-2765
US

V. Phone/Fax

Practice location:
  • Phone: 229-353-6184
  • Fax:
Mailing address:
  • Phone: 229-237-0737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN283995
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: