Provider Demographics
NPI:1003148925
Name:MILLS, JULIAN DAVIS (MT, CLT)
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:DAVIS
Last Name:MILLS
Suffix:
Gender:F
Credentials:MT, CLT
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:D
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3280 PATE DR
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-5021
Mailing Address - Country:US
Mailing Address - Phone:770-403-3794
Mailing Address - Fax:
Practice Address - Street 1:3280 PATE DR
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-5021
Practice Address - Country:US
Practice Address - Phone:770-403-3794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT004927225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist