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NPI Code Detail

MEDICARE: MR. CLEOPHAS LOUIS MCMILLAN M.ED.

MEDICARE:  MR. CLEOPHAS LOUIS MCMILLAN  M.ED.
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
1235Z00000XSpeech-Language Pathologist6211NC

General Provider Information

NPI Number : 1912039934
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CLEOPHAS LOUIS MCMILLAN M.ED.
Provider Business Mailing Address
First Line : 404 MCLEOD RD
Second Line :
City : RED SPRINGS
State : NC
Zip : 28377-1952
Country : US
Telephone Number : 910-843-5464
Fax Number :
Provider Business Practice Location Address
First Line : 404 MCLEOD RD
Second Line :
City : RED SPRINGS
State : NC
Zip : 28377-1952
Country : US
Telephone Number : 910-843-5464
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2007
Last Update Date : 07/08/2007

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Directions to “ MR. CLEOPHAS LOUIS MCMILLAN M.ED.” Practice Location

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