Healthcare Provider Details

I. General information

NPI: 1427020767
Provider Name (Legal Business Name): MR. RAYMOND GLENN MILLS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 JOHN PAUL JONES CIR
PORTSMOUTH VA
23708-2111
US

IV. Provider business mailing address

4032 DEVON DR
CHESAPEAKE VA
23321-1862
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-7641
  • Fax: 757-953-6081
Mailing address:
  • Phone: 757-465-5528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: