Provider Demographics
NPI:1093743742
Name:BYRD, MILLICENT M (RN)
Entity type:Individual
Prefix:MS
First Name:MILLICENT
Middle Name:M
Last Name:BYRD
Suffix:
Gender:F
Credentials:RN
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Mailing Address - Street 1:3283 JACK RUSSELL RUN
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-7518
Mailing Address - Country:US
Mailing Address - Phone:404-321-6111
Mailing Address - Fax:404-235-3038
Practice Address - Street 1:1670 CLAIRMONT RD
Practice Address - Street 2:170-C
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4004
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:404-235-3038
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN 144078163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN144078OtherNURSING LICENSE