Healthcare Provider Details

I. General information

NPI: 1043380777
Provider Name (Legal Business Name): LESLIE CAROL MILLS RN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLIE CAROL MEDFORD RN, CPNP

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 DANTIGNAC ST STE 2600
AUGUSTA GA
30901-2796
US

IV. Provider business mailing address

411 TOWN PARK BLVD
EVANS GA
30809-3487
US

V. Phone/Fax

Practice location:
  • Phone: 706-854-2500
  • Fax: 706-854-2559
Mailing address:
  • Phone: 706-854-2500
  • Fax: 706-854-2559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRN077228
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN077228
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberGAA-NP004358
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: