Provider Demographics
NPI:1962754010
Name:MILLS, GARY EUGENE (BC-HIS)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:EUGENE
Last Name:MILLS
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S 27TH AVE STE 20
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7168
Mailing Address - Country:US
Mailing Address - Phone:601-602-3320
Mailing Address - Fax:601-602-3322
Practice Address - Street 1:201 S 27TH AVE STE 20
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7168
Practice Address - Country:US
Practice Address - Phone:601-602-3320
Practice Address - Fax:601-602-3322
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSHA0593237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist