=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356488761
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK A. MILLS PA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2007
-----------------------------------------------------
Last Update Date | 12/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3465 MACON RD STE D
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31907-2582
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-243-3051
-----------------------------------------------------
Fax | 706-243-2027
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6600 VAN AALST BLVD BLDG 9250
-----------------------------------------------------
City | FORT BENNING
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31905-2102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-544-2625
-----------------------------------------------------
Fax | 762-408-8154
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 002938
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------