Healthcare Provider Details

I. General information

NPI: 1437601234
Provider Name (Legal Business Name): NICHOLAS MILLS MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2951 DOCTORS PARK DR
MEDFORD OR
97504-8127
US

IV. Provider business mailing address

2951 DOCTORS PARK DR
MEDFORD OR
97504-8127
US

V. Phone/Fax

Practice location:
  • Phone: 541-200-2646
  • Fax: 541-200-2649
Mailing address:
  • Phone: 541-200-2646
  • Fax: 541-200-2649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number154375
License Number StateOR

VIII. Authorized Official

Name: JESSICA DAVIS
Title or Position: OFFICE MANAGER
Credential:
Phone: 541-200-2043