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General NPI Number Information
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NPI Number | 1780668327
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Entity Type | Organization
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Legal Business Name | MILAM PROFESSIONAL SERVICES
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Dates
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Enumeration Date | 12/06/2005
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Last Update Date | 01/02/2010
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Provider Practice Location Address
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Address Line | 5429 WRIGHTSVILLE AVE
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City | WILMINGTON
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State | NC
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Zip | 28403-6513
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Country | US
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Telephone | 910-792-1001
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Fax |
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Provider Business Mailing Address
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Address Line | 5429 WRIGHTSVILLE AVE
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City | WILMINGTON
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State | NC
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Zip | 28403-6513
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Country | US
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Telephone | 910-792-1001
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS R MILAM
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Credential | MD
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Telephone | 910-792-1001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 9901262
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License Number State | NC
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