=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801752803
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MILFORD MEDICAL MANGEMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2026
-----------------------------------------------------
Last Update Date | 01/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 455 WESTBOURNE DR
-----------------------------------------------------
City | TYRONE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30290-1647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-293-1109
-----------------------------------------------------
Fax | 770-407-5128
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1029 N PEACHTREE PKWY STE 344
-----------------------------------------------------
City | PEACHTREE CITY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30269-4210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-293-1109
-----------------------------------------------------
Fax | 404-293-1109
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BRANDI SHANTELLE MILFORD
-----------------------------------------------------
Credential | MS, CRC, CCM
-----------------------------------------------------
Telephone | 404-293-1109
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------