MEDICARE: DR. SANDRA S. MILLS PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	511	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	03872	OTHER	NC	BLUECROSSBLUESHIELD

General Provider Information

NPI Number	:	1750352571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA S. MILLS PH.D.

Provider Business Mailing Address
First Line	:	2311 WEST CONE BLVD
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27408-4029
Country	:	US
Telephone Number	:	336-540-1256
Fax Number	:	336-540-1266

Provider Business Practice Location Address
First Line	:	2311 WEST CONE BLVD
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27408-4029
Country	:	US
Telephone Number	:	336-540-1256
Fax Number	:	336-540-1266

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	07/08/2007

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