Provider Demographics
NPI:1053675470
Name:MCMILLIAN, CHARLES EUGENE
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:EUGENE
Last Name:MCMILLIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 CARLOS LN APT B
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-6822
Mailing Address - Country:US
Mailing Address - Phone:775-200-3952
Mailing Address - Fax:
Practice Address - Street 1:2470 WRONDEL WAY # 275
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3701
Practice Address - Country:US
Practice Address - Phone:775-336-2812
Practice Address - Fax:775-336-1082
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator