Provider Demographics
NPI:1154790228
Name:MILLS, ALEXANDER JOHN
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:JOHN
Last Name:MILLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 KILLIS BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:NC
Mailing Address - Zip Code:28574-6397
Mailing Address - Country:US
Mailing Address - Phone:314-698-6279
Mailing Address - Fax:
Practice Address - Street 1:2189 ELROD AVE
Practice Address - Street 2:
Practice Address - City:QUANTICO
Practice Address - State:VA
Practice Address - Zip Code:22134-5113
Practice Address - Country:US
Practice Address - Phone:703-784-2063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman