Healthcare Provider Details

I. General information

NPI: 1790886133
Provider Name (Legal Business Name): BEVERLY ANN MCMILLAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 RIVER OAKS DR SUITE 320
JACKSON MS
39232-9500
US

IV. Provider business mailing address

1020 RIVER OAKS DR SUITE 320
JACKSON MS
39232-9500
US

V. Phone/Fax

Practice location:
  • Phone: 601-936-1400
  • Fax: 601-936-0671
Mailing address:
  • Phone: 601-936-1400
  • Fax: 601-936-0671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number07159
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: