Provider Demographics
NPI:1235157744
Name:MILLS, COUNCIL CLAYTON III (MD)
Entity Type:Individual
Prefix:DR
First Name:COUNCIL
Middle Name:CLAYTON
Last Name:MILLS
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:5410 MARYLAND WAY SUITE 300
Mailing Address - Street 2:COGENT HEALTHCARE
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027
Mailing Address - Country:US
Mailing Address - Phone:615-377-5658
Mailing Address - Fax:615-373-5280
Practice Address - Street 1:2670 E 29TH ST STE A
Practice Address - Street 2:COGENT HEALTHCARE OF TEXAS, PA
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2501
Practice Address - Country:US
Practice Address - Phone:979-776-5967
Practice Address - Fax:979-774-4849
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2010-02-23
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Provider Licenses
StateLicense IDTaxonomies
TXE6523207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE6523OtherSTATE
TX8CB434OtherBCBS
TX114274704Medicaid
TX8CB434OtherBCBS
TXE6523OtherSTATE
TX114274704Medicaid