Healthcare Provider Details

I. General information

NPI: 1902433485
Provider Name (Legal Business Name): MARY PATE MILLS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6918 MCGINNIS FERRY RD STE 200
SUWANEE GA
30024-1258
US

IV. Provider business mailing address

745 THORNBERRY DR
ALPHARETTA GA
30022-4873
US

V. Phone/Fax

Practice location:
  • Phone: 770-622-5758
  • Fax: 770-622-5717
Mailing address:
  • Phone: 770-853-4190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number94206
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: