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General NPI Number Information
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NPI Number | 1235220112
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Entity Type | Organization
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Legal Business Name | EAST LAKELAND OB GYN ASSOCIATES, P.A.
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | 1020 RIVER OAKS DR SUITE 320
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City | JACKSON
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State | MS
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Zip | 39232-9500
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Country | US
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Telephone | 601-936-1400
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Fax | 601-936-0671
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Provider Business Mailing Address
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Address Line | 1020 RIVER OAKS DR SUITE 320
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City | JACKSON
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State | MS
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Zip | 39232-9500
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Country | US
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Telephone | 601-936-1400
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Fax | 601-936-0671
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BEVERLY ANN MCMILLAN
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Credential | M.D.
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Telephone | 601-936-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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