Provider Demographics
NPI:1538225529
Name:MILLIGAN MED PED LLC
Entity type:Organization
Organization Name:MILLIGAN MED PED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORBI
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-223-5656
Mailing Address - Street 1:300 STONECREST BLVD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-5688
Mailing Address - Country:US
Mailing Address - Phone:615-223-5656
Mailing Address - Fax:
Practice Address - Street 1:300 STONECREST BLVD.
Practice Address - Street 2:SUITE 290
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-5688
Practice Address - Country:US
Practice Address - Phone:615-223-5656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000038938305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNMD0000038938OtherSTATE LICENSE#
TN1306894860OtherNPI # CORBI MILLIGAN MD
TN1306894860OtherNPI # CORBI MILLIGAN MD
TNMD0000038938OtherSTATE LICENSE#
TNI18355Medicare UPIN