Healthcare Provider Details

I. General information

NPI: 1013901289
Provider Name (Legal Business Name): RODNEY MOORE MCMILLIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 N ROANE ST
HARRIMAN TN
37748-2057
US

IV. Provider business mailing address

408 N ROANE ST
HARRIMAN TN
37748-2057
US

V. Phone/Fax

Practice location:
  • Phone: 865-882-3745
  • Fax: 865-882-6072
Mailing address:
  • Phone: 865-882-3745
  • Fax: 865-882-6072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11665
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: