Provider Demographics
NPI:1760463376
Name:LAMPTEY-MILLS, ISHMAEL (MD)
Entity Type:Individual
Prefix:
First Name:ISHMAEL
Middle Name:
Last Name:LAMPTEY-MILLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 BAXTER ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-3712
Mailing Address - Country:US
Mailing Address - Phone:706-389-3410
Mailing Address - Fax:706-389-3411
Practice Address - Street 1:1230 BAXTER ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606
Practice Address - Country:US
Practice Address - Phone:706-389-3410
Practice Address - Fax:706-389-3411
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35085875207R00000X
GA058894208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52245821OtherBCBS
GA748327982EMedicaid
GA9436565OtherCIGNA
GA110029C052131OtherTRAILBLAZERS
GA1760463376OtherTRICARE
GA748327982HMedicaid
GA748327982NMedicaid
GA01240275OtherAMERIGROUP
GA473536OtherWELLCARE
GA748327982AMedicaid
GA748327982CMedicaid
GA9220306OtherAETNA
GA748327982BMedicaid
GA748327982DMedicaid
GAP00755797OtherRAILROAD MEDICARE
GA748327982EMedicaid
GA1760463376OtherTRICARE