Provider Demographics
NPI:1215054085
Name:MILLS, HARRY JACOB II (MED, ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:HARRY
Middle Name:JACOB
Last Name:MILLS
Suffix:II
Gender:M
Credentials:MED, ATC, LAT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:62 CENTERPORT DR
Mailing Address - Street 2:
Mailing Address - City:WHITE
Mailing Address - State:GA
Mailing Address - Zip Code:30184-2770
Mailing Address - Country:US
Mailing Address - Phone:706-509-3400
Mailing Address - Fax:706-509-3406
Practice Address - Street 1:304 SHORTER AVE NW
Practice Address - Street 2:SUITE 101
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-4290
Practice Address - Country:US
Practice Address - Phone:706-509-3400
Practice Address - Fax:706-509-3406
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA00012992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer