Mill Creek Clinic, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

26446 Issued in GA

Legal business name

MILL CREEK CLINIC, LLC

Practice address

7824 Hickory Flat Hwy Ste 120
Woodstock, GA 30188-6575

Phone

(770) 604-1930

Fax

(770) 604-1929

NPI assigned

Feb 23, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Sheryl Bailey Vickery, M.D

Title

Owner

Phone

(770) 378-0328

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1424649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552953600000",
    "number": "1700278199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6175 HICKORY FLAT HWY",
            "address_2": "STE 110-343",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301157207",
            "telephone_number": "770-704-4911",
            "fax_number": "770-704-4922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7824 HICKORY FLAT HWY STE 120",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301886575",
            "telephone_number": "770-604-1930",
            "fax_number": "770-604-1929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILL CREEK CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-23",
        "last_updated": "2019-03-19",
        "status": "A",
        "authorized_official_last_name": "VICKERY",
        "authorized_official_first_name": "SHERYL",
        "authorized_official_middle_name": "BAILEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-378-0328",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "26446",
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "883092643D",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Kiana Miles, RBT
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• Gary Michael Miller, MD
• Kyrei Jendaya Miller, OTR/L
• Brittany Dawn Mills
• Mimi McDonald LLC

• Primary Care Clinic/Center in Woodstock, GA
• Providers in Woodstock, GA by specialty
• Primary Care Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.