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General NPI Number Information
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NPI Number | 1114352093
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Entity Type | Individual
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Provider Name | JESSICA ANNE MCMILLAN LMFT
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Gender | Female
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Dates
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Enumeration Date | 09/10/2013
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Last Update Date | 09/10/2013
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Provider Practice Location Address
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Address Line | 1827 POWERS FERRY RD SE BUILDING 7 SUITE 350
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City | ATLANTA
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State | GA
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Zip | 30339-5621
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Country | US
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Telephone | 404-316-2271
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Fax |
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Provider Business Mailing Address
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Address Line | 1708 SCOTT BLVD
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City | DECATUR
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State | GA
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Zip | 30033-5613
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Country | US
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Telephone | 404-316-2271
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT001308
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License Number State | GA
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