MEDICARE: MS. TAMMY B MCMILLAN

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	363LF0000X	Family Nurse Practitioner	24552	SC
2	163W00000X	Registered Nurse	92865	SC

General Provider Information

NPI Number	:	1932712148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAMMY B MCMILLAN

Provider Business Mailing Address
First Line	:	4604 IRONWOOD RD
Second Line	:
City	:	MULLINS
State	:	SC
Zip	:	29574-6885
Country	:	US
Telephone Number	:	843-468-1299
Fax Number	:

Provider Business Practice Location Address
First Line	:	4604 IRONWOOD RD
Second Line	:
City	:	MULLINS
State	:	SC
Zip	:	29574-6885
Country	:	US
Telephone Number	:	843-468-1299
Fax Number	:

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

Provider Enumeration Date	:	08/26/2020
Last Update Date	:	02/09/2026

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