Healthcare Provider Details

I. General information

NPI: 1801752803
Provider Name (Legal Business Name): MILFORD MEDICAL MANGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2026
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 WESTBOURNE DR
TYRONE GA
30290-1647
US

IV. Provider business mailing address

1029 N PEACHTREE PKWY STE 344
PEACHTREE CITY GA
30269-4210
US

V. Phone/Fax

Practice location:
  • Phone: 404-293-1109
  • Fax: 770-407-5128
Mailing address:
  • Phone: 404-293-1109
  • Fax: 404-293-1109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: BRANDI SHANTELLE MILFORD
Title or Position: OWNER
Credential: MS, CRC, CCM
Phone: 404-293-1109