Provider Demographics
NPI:1639147820
Name:MILLS, MARVIN L (MD FACC PC)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:L
Last Name:MILLS
Suffix:
Gender:M
Credentials:MD FACC PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA18710207RC0000X
TN7784207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA408113152OtherRR MCRE
GA000119996AMedicaid
TN2004595OtherBS TN
TN2004595OtherBS TN