Healthcare Provider Details

I. General information

NPI: 1952306797
Provider Name (Legal Business Name): JUSTIN GERARD MILLS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 HAWTHORNE AVE
COLUMBUS OH
43203-1665
US

IV. Provider business mailing address

PO BOX 2026
FAIRBORN OH
45324-8026
US

V. Phone/Fax

Practice location:
  • Phone: 937-789-3423
  • Fax:
Mailing address:
  • Phone: 937-751-7477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number35-05-0604-M
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35050604
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: