Provider Demographics
NPI:1063147510
Name:MCMILLAN, SHERRY VANESSA
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:VANESSA
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10082 CROSS HILL RD
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-0137
Mailing Address - Country:US
Mailing Address - Phone:912-412-7178
Mailing Address - Fax:912-888-1192
Practice Address - Street 1:10082 CROSS HILL RD
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-0137
Practice Address - Country:US
Practice Address - Phone:912-412-7178
Practice Address - Fax:912-888-1192
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker