Healthcare Provider Details

I. General information

NPI: 1376554220
Provider Name (Legal Business Name): DAVID MCIVER MILLSAPS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 GRAYSTONE PL
CONOVER NC
28613-8200
US

IV. Provider business mailing address

PO BOX 1347
HICKORY NC
28603-1347
US

V. Phone/Fax

Practice location:
  • Phone: 828-328-1118
  • Fax: 828-328-1119
Mailing address:
  • Phone: 828-328-1118
  • Fax: 828-328-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number23132
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: