Healthcare Provider Details

I. General information

NPI: 1013288919
Provider Name (Legal Business Name): KEVIN MILLS MCNEILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2012
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 CALUMET DR
MADISON MS
39110-9298
US

IV. Provider business mailing address

1710 WHITEHOUSE CT
DALTON GA
30720-8523
US

V. Phone/Fax

Practice location:
  • Phone: 601-605-8956
  • Fax:
Mailing address:
  • Phone: 601-813-3527
  • Fax: 706-529-5740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberMD 20852
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number051163
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number07335
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: