Healthcare Provider Details

I. General information

NPI: 1790699700
Provider Name (Legal Business Name): KATIE SCAGGS MILLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 NORTHSIDE DR
VALDOSTA GA
31602-1801
US

IV. Provider business mailing address

4660 BARRETT COODY RD
VALDOSTA GA
31601-1546
US

V. Phone/Fax

Practice location:
  • Phone: 229-375-4776
  • Fax:
Mailing address:
  • Phone: 229-375-4776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT015363
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: