Basic Information
Provider Information
NPI: 1669460739
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MILNER
FirstName: JAMES
MiddleName: EDWARD
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1623 MADISON AVE
Address2:  
City: TIFTON
State: GA
PostalCode: 317943757
CountryCode: US
TelephoneNumber: 2293537720
FaxNumber: 2293537791
Practice Location
Address1: 901 18TH ST E
Address2:  
City: TIFTON
State: GA
PostalCode: 317943648
CountryCode: US
TelephoneNumber: 2293534325
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/12/2005
LastUpdateDate: 12/01/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/01/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RX0202X32434GAY Allopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology

No ID Information.


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