Provider Demographics
NPI:1699242719
Name:MILLSAP, NADIA
Entity type:Individual
Prefix:
First Name:NADIA
Middle Name:
Last Name:MILLSAP
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 1:5379 PONDEROSA FARM RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30507-8761
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5379 PONDEROSA FARM RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30507-8761
Practice Address - Country:US
Practice Address - Phone:678-736-1490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-26
Last Update Date:2021-04-14
Deactivation Date:2021-03-22
Deactivation Code:
Reactivation Date:2021-04-14
Provider Licenses
StateLicense IDTaxonomies
GASLP010253235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist