Individual provider Active NPI

Traci D McMillian, MD

  • Family Medicine Physician
  • King, NC
National Provider Identifier
1821064189
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
9900940 Issued in NC
Practice address
216 Moore Rd
King, NC 27021-8703
Phone
(336) 983-4346
NPI assigned
Feb 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 9900940 NC Primary

Addresses

Primary practice location

216 Moore Rd
King, NC 27021-8703

Mailing address

2000 Frontis Plaza Blvd Ste 200
Attn Forsyth Medical Group
Winston Salem, NC 27103-5616
Phone (336) 277-2436

Other identifiers 1

IdentifierTypeStateIssuer
891280GMedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
9900940NCMDFamily Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1140998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1821064189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 FRONTIS PLAZA BLVD STE 200",
            "address_2": "ATTN FORSYTH MEDICAL GROUP",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271035616",
            "telephone_number": "336-277-2436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 MOORE RD",
            "city": "KING",
            "state": "NC",
            "postal_code": "270218703",
            "telephone_number": "336-983-4346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCMILLIAN",
        "first_name": "TRACI",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "9900940",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891280G",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in King, NC

Sources for this page

Verify at the official NPI Registry.