Provider Demographics
NPI:1104144401
Name:MCMILLAN, LAURENCE DERICH (MD)
Entity type:Individual
Prefix:
First Name:LAURENCE
Middle Name:DERICH
Last Name:MCMILLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1713 7TH AVE S
Mailing Address - Street 2:SPARKS CENTER SC 932
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-0017
Mailing Address - Country:US
Mailing Address - Phone:205-994-4310
Mailing Address - Fax:
Practice Address - Street 1:251 N BAYOU ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36603-5827
Practice Address - Country:US
Practice Address - Phone:251-263-1956
Practice Address - Fax:251-690-8987
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL382422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry