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General NPI Number Information
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NPI Number | 1649328030
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Entity Type | Organization
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Legal Business Name | MILLS CLINIC A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 10/14/2008
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Provider Practice Location Address
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Address Line | 7225 FERN AVENUE SUITE 600
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City | SHREVEPORT
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State | LA
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Zip | 71105-4981
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Country | US
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Telephone | 318-629-3630
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Fax | 318-629-3640
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Provider Business Mailing Address
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Address Line | 7225 FERN AVENUE SUITE 600
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City | SHREVEPORT
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State | LA
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Zip | 71105-4981
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Country | US
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Telephone | 318-629-3630
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Fax | 318-629-3640
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Authorized Official
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Title or Position | MD OWNER PRESIDENT
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Name | DR. BRYAN HAYWOOD MILLS
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Credential | MD
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Telephone | 318-629-3630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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