Healthcare Provider Details

I. General information

NPI: 1689659674
Provider Name (Legal Business Name): CHARLES R MILLS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 E HERITAGE PKWY
FARMINGTON AR
72730-5529
US

IV. Provider business mailing address

PO BOX 497
AUGUSTA AR
72006-0497
US

V. Phone/Fax

Practice location:
  • Phone: 479-400-1140
  • Fax: 479-400-1151
Mailing address:
  • Phone: 870-347-2534
  • Fax: 870-347-1235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberE-5405
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: