Provider Demographics
NPI:1497889802
Name:MILLS, SUSAN LEANNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LEANNE
Last Name:MILLS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:487 SHARP MOUNTAIN PKWY
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-4848
Mailing Address - Country:US
Mailing Address - Phone:770-735-1329
Mailing Address - Fax:
Practice Address - Street 1:1449 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4075
Practice Address - Country:US
Practice Address - Phone:706-692-2686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist