MEDICARE: DR. MICHAEL R MILLNER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085B0100X	Body Imaging Physician	030654	GA
2	2085D0003X	Diagnostic Neuroimaging (Radiology) Physician	030654	GA
3	2085N0700X	Neuroradiology Physician	030654	GA
4	2085N0904X	Nuclear Radiology Physician	030654	GA
5	2085P0229X	Pediatric Radiology Physician	030654	GA
6	2085R0202X	Diagnostic Radiology Physician	030654	GA
7	2085R0204X	Vascular & Interventional Radiology Physician	030654	GA
8	2085U0001X	Diagnostic Ultrasound Physician	030654	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1952419012	OTHER	NPI - STH. GA RADIOLOGY

General Provider Information

NPI Number	:	1447200399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL R MILLNER M.D.

Provider Business Mailing Address
First Line	:	1125 TROUPE ST
Second Line	:	P.O. BOX 3201
City	:	AUGUSTA
State	:	GA
Zip	:	30904-4480
Country	:	US
Telephone Number	:	706-737-4575
Fax Number	:	706-731-5289

Provider Business Practice Location Address
First Line	:	2501 N PATTERSON ST
Second Line	:
City	:	VALDOSTA
State	:	GA
Zip	:	31602-2511
Country	:	US
Telephone Number	:	229-259-4888
Fax Number	:	229-559-8178

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	10/31/2013

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Directions to “ DR. MICHAEL R MILLNER M.D.” Practice Location

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