Healthcare Provider Details

I. General information

NPI: 1902847445
Provider Name (Legal Business Name): WESLEY C MILLS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8075 GATE PARKWAY WEST SUITE 202
JACKSONVILLE FL
32216-3685
US

IV. Provider business mailing address

8075 GATE PARKWAY WEST SUITE 202
JACKSONVILLE FL
32216-3685
US

V. Phone/Fax

Practice location:
  • Phone: 904-400-6500
  • Fax: 904-400-6501
Mailing address:
  • Phone: 904-400-6500
  • Fax: 904-400-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME83961
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: