Provider Demographics
NPI:1730159088
Name:MILLIGAN, LESLIE WALTON (MD)
Entity type:Individual
Prefix:MR
First Name:LESLIE
Middle Name:WALTON
Last Name:MILLIGAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1810 BISHOP STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760
Mailing Address - Country:US
Mailing Address - Phone:865-475-2061
Mailing Address - Fax:865-475-0739
Practice Address - Street 1:1810 BISHOP STREET
Practice Address - Street 2:SUITE C
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760
Practice Address - Country:US
Practice Address - Phone:865-475-2061
Practice Address - Fax:865-475-0739
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2010-03-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD007731208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3153086Medicaid
B02441Medicare UPIN
TN3153086Medicaid