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General NPI Number Information
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NPI Number | 1205505344
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Entity Type | Organization
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Legal Business Name | MILLS FAMILY PRACTICE
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Dates
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Enumeration Date | 09/11/2021
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Last Update Date | 01/18/2022
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Provider Practice Location Address
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Address Line | 1320 SEYMOUR DR
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City | SOUTH BOSTON
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State | VA
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Zip | 24592-3900
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Country | US
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Telephone | 434-579-0069
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1303
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City | SOUTH BOSTON
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State | VA
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Zip | 24592-1303
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Country | US
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Telephone | 434-404-3970
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Fax | 434-404-3371
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KENNETH EUGENE MILLS JR.
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Credential |
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Telephone | 434-404-3970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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