Provider Demographics
NPI:1487610945
Name:MILLS, PHILIP R (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:R
Last Name:MILLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PHILIP
Other - Middle Name:R
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:101 RIVERSTONE VIS
Mailing Address - Street 2:SUITE 215
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-6648
Mailing Address - Country:US
Mailing Address - Phone:706-946-4222
Mailing Address - Fax:706-946-4223
Practice Address - Street 1:101 RIVERSTONE VIS
Practice Address - Street 2:SUITE 205
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-6648
Practice Address - Country:US
Practice Address - Phone:706-632-4100
Practice Address - Fax:706-632-3585
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA05316207N00000X
GA56316208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA685603253CMedicaid
GA685603253CMedicaid
GA07BBSSLMedicare PIN