Healthcare Provider Details

I. General information

NPI: 1467377374
Provider Name (Legal Business Name): MRS. PATRIA GOODWIN MCMILLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 EXECUTIVE CENTER DR STE 201B
CHARLOTTE NC
28212-8841
US

IV. Provider business mailing address

119 JODIE DR
HAMLET NC
28345-3672
US

V. Phone/Fax

Practice location:
  • Phone: 704-977-1291
  • Fax:
Mailing address:
  • Phone: 910-206-8402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: