Healthcare Provider Details

I. General information

NPI: 1265478234
Provider Name (Legal Business Name): ANTHONY DWAYNE MILLS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 04/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 OLD ROSWELL PL SUITE J100
ROSWELL GA
30076-1670
US

IV. Provider business mailing address

770 OLD ROSWELL PL SUITE J100
ROSWELL GA
30076-1670
US

V. Phone/Fax

Practice location:
  • Phone: 404-547-7450
  • Fax: 770-643-2011
Mailing address:
  • Phone: 404-547-7450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number044023
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number044023
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: