Provider Demographics
NPI:1326391657
Name:MARVIN L. MILLS, M.D., P.C.
Entity Type:Organization
Organization Name:MARVIN L. MILLS, M.D., P.C.
Other - Org Name:MARVIN L. MILLS, M.D., F.A.C.C., P.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-820-2060
Mailing Address - Street 1:2367 CHATTANOOGA VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:FLINTSTONE
Mailing Address - State:GA
Mailing Address - Zip Code:30725-2035
Mailing Address - Country:US
Mailing Address - Phone:706-820-2060
Mailing Address - Fax:706-820-2090
Practice Address - Street 1:2367 CHATTANOOGA VALLEY RD
Practice Address - Street 2:
Practice Address - City:FLINTSTONE
Practice Address - State:GA
Practice Address - Zip Code:30725-2035
Practice Address - Country:US
Practice Address - Phone:706-820-2060
Practice Address - Fax:706-820-2090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA18710207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000119996AMedicaid
GAD40666Medicare UPIN
GA413701597CMedicare PIN