MEDICARE: BARBARA MCMILLAN-PERSAUD 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	207Q00000X	Family Medicine Physician	046887	GA

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	:	1831186857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA MCMILLAN-PERSAUD M.D

Provider Business Mailing Address
First Line	:	1046 RIDGE AVE SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-1640
Country	:	US
Telephone Number	:	404-688-1350
Fax Number	:	404-688-2962

Provider Business Practice Location Address
First Line	:	1513 E. CLEVELAND AVE.
Second Line	:	BLDG. 500
City	:	EAST POINT
State	:	GA
Zip	:	30334-1640
Country	:	US
Telephone Number	:	404-752-1000
Fax Number	:	404-688-2962

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	02/28/2014

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