Provider Demographics
NPI:1265478234
Name:MILLS, ANTHONY DWAYNE (MD)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:DWAYNE
Last Name:MILLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:770 OLD ROSWELL PL
Mailing Address - Street 2:SUITE J100
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1670
Mailing Address - Country:US
Mailing Address - Phone:404-547-7450
Mailing Address - Fax:
Practice Address - Street 1:770 OLD ROSWELL PL
Practice Address - Street 2:SUITE J100
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1670
Practice Address - Country:US
Practice Address - Phone:404-547-7450
Practice Address - Fax:770-643-2011
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044023207V00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA044023OtherGA MEDICAL LIC
IL36092640OtherILLINOIS MEDICAL LIC
GA11343981OtherCAQH IDENTIFIER
GA000762088DMedicaid
GA044023OtherGA MEDICAL LIC
GA000762088DMedicaid