Provider Demographics
NPI:1407848716
Name:MILLS, R SCOTT (MD)
Entity type:Individual
Prefix:
First Name:R SCOTT
Middle Name:
Last Name:MILLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 CHURCH ST NE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7282
Mailing Address - Country:US
Mailing Address - Phone:678-797-8201
Mailing Address - Fax:678-797-8259
Practice Address - Street 1:790 CHURCH ST NE
Practice Address - Street 2:SUITE 230
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7282
Practice Address - Country:US
Practice Address - Phone:678-797-8201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038308207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000661537BMedicaid
GAP00155698OtherRAILROAD MEDICARE
GA320125OtherWELLCARE
GAG05400Medicare UPIN
GA11SCDFSMedicare ID - Type Unspecified