Healthcare Provider Details

I. General information

NPI: 1275988354
Provider Name (Legal Business Name): CLIFFORD ALLEN GAVIN-MILLS JR. LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 JOHNSON FY RD NE
SANDY SPRINGS GA
30342-1605
US

IV. Provider business mailing address

5006 GROOVER DR SE
SMYRNA GA
30080-7222
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-3993
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW006943
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: