Provider Demographics
NPI:1871703587
Name:MCMILLAN, GEORGE (PT)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:MCMILLAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 OVERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-1345
Mailing Address - Country:US
Mailing Address - Phone:856-317-5718
Mailing Address - Fax:
Practice Address - Street 1:321 NORRISTOWN RD
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-2755
Practice Address - Country:US
Practice Address - Phone:866-736-9654
Practice Address - Fax:877-636-9653
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007935-L171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor