Healthcare Provider Details

I. General information

NPI: 1487864922
Provider Name (Legal Business Name): THOMAS P. MILLS, M.D., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 LAKELAND DR SUITE 49
JACKSON MS
39216-4634
US

IV. Provider business mailing address

970 LAKELAND DR SUITE 49
JACKSON MS
39216-4634
US

V. Phone/Fax

Practice location:
  • Phone: 601-987-4463
  • Fax:
Mailing address:
  • Phone: 601-987-4463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number11853
License Number StateMS

VIII. Authorized Official

Name: DR. THOMAS P. MILLS
Title or Position: SOLE MANAGER, MEMBER, & OWNER
Credential: M.D.
Phone: 601-987-4463