Provider Demographics
NPI:1043811581
Name:MCMILLAN, NADINE WALKER (SLP)
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:WALKER
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 E CHEROKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-3302
Mailing Address - Country:US
Mailing Address - Phone:470-423-9477
Mailing Address - Fax:
Practice Address - Street 1:7 E CHEROKEE AVE
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3302
Practice Address - Country:US
Practice Address - Phone:470-423-9477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006702235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist