Provider Demographics
NPI:1639130602
Name:MILLS, JANETE M (MD)
Entity Type:Individual
Prefix:
First Name:JANETE
Middle Name:M
Last Name:MILLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9568 KINGS CHARTER DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-0078
Mailing Address - Country:US
Mailing Address - Phone:804-266-8717
Mailing Address - Fax:804-266-5677
Practice Address - Street 1:1144A N. ROAD STREET
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:VA
Practice Address - Zip Code:27909
Practice Address - Country:US
Practice Address - Phone:252-384-4122
Practice Address - Fax:252-384-4220
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC100085942085R0001X
VA01010545942085R0001X
NC2013-008612085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2486021003OtherCIGNA
2123336OtherAETNA
334073OtherANTHEM
DE1639130602Medicaid
920004542OtherRAILROAD MEDICARE
DE2177873OtherMAMSI & ONE-NET PPO
289344OtherMAMSI
330472OtherCAREFIRST
5119504OtherAETNA
DE2177873OtherMAMSI & ONE-NET PPO
DE003478D21Medicare PIN