Provider Demographics
NPI:1942295894
Name:MILLS, RALPH LEE (MD)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:LEE
Last Name:MILLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684-0699
Mailing Address - Country:US
Mailing Address - Phone:423-439-4044
Mailing Address - Fax:423-439-5264
Practice Address - Street 1:JOHN ROBERT BELL DR
Practice Address - Street 2:MINI-DOME
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37614-1700
Practice Address - Country:US
Practice Address - Phone:423-439-4044
Practice Address - Fax:423-439-5264
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15784207X00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ010184Medicaid
NC5903982Medicaid
TN200040317Medicare PIN
TNA97479Medicare UPIN
NC5903982Medicaid
TN103I082843Medicare PIN
TN3828857Medicaid
TN0443950005Medicare NSC