Healthcare Provider Details

I. General information

NPI: 1083646293
Provider Name (Legal Business Name): GREGORY DOUGLAS MILLS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 EAST ROUTE 70 STE L60
CHERRY HILL NJ
08003
US

IV. Provider business mailing address

1930 EAST ROUTE 70 STE L60
CHERRY HILL NJ
08003
US

V. Phone/Fax

Practice location:
  • Phone: 856-751-3313
  • Fax: 856-751-8370
Mailing address:
  • Phone: 856-751-3313
  • Fax: 856-751-8370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberMD1968
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: