Provider Demographics
NPI:1114040763
Name:MILLS, MARK GREGORY (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:GREGORY
Last Name:MILLS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1850 EPPS BRIDGE PKWY STE 325
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-6186
Mailing Address - Country:US
Mailing Address - Phone:706-433-0311
Mailing Address - Fax:706-433-0312
Practice Address - Street 1:1850 EPPS BRIDGE PKWY STE 325
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6186
Practice Address - Country:US
Practice Address - Phone:706-433-0311
Practice Address - Fax:706-433-0312
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1288152W00000X
SC1550152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAOPT001288OtherGA. LICENSE
SC1550OtherSOUTH CAROLINA BOARD OF OPTOMETRY
MM0517827OtherDEA