| NPI | 1174260079 |
|---|---|
| Other Name | SHANNON MCMILLAN |
| Entity Type | Organization |
| Authorized Contact | STEPHANIE GAIL HALL Medical Biller And Credentialer 502-931-4065 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Enumeration Date | 2022-05-12 |
| Last Update Date | 2022-06-09 |