MEDICARE: AUDREY MILAM

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	106S00000X	Behavior Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447874144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY MILAM

Provider Business Mailing Address
First Line	:	1731 SW 66TH DR
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32607-5369
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 SW 2ND AVE STE U
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32607-2802
Country	:	US
Telephone Number	:	561-809-5074
Fax Number	:

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

Provider Enumeration Date	:	05/29/2020
Last Update Date	:	05/29/2020

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Directions to “ AUDREY MILAM ” Practice Location

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