Provider Demographics
NPI:1942384839
Name:MILLS, ALYSSA A (MD)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:A
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-5701
Mailing Address - Fax:704-384-5642
Practice Address - Street 1:1718 E 4TH ST
Practice Address - Street 2:SUITE 404
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3261
Practice Address - Country:US
Practice Address - Phone:704-384-5701
Practice Address - Fax:704-384-5642
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2004-00544207VM0101X
IN01068561A207VM0101X
NC2004-00554207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903342Medicaid
NC891367Medicaid
NC1367VOtherNCBCBS
SCQ0055CMedicaid
NC891367Medicaid
NCI14467Medicare UPIN
I14467Medicare UPIN
NC2031765AMedicare PIN