Organization
MILLS CLINIC A PROFESSIONAL MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYAN HAYWOOD MILLS MD (MD OWNER PRESIDENT)
(318) 629-3630
Entity
Organization
Contact information
Practice address
7225 FERN AVENUE, SUITE 600, SHREVEPORT, LA 71105-4981
(318) 629-3630
(318) 629-3640
Mailing address
7225 FERN AVENUE, SUITE 600, SHREVEPORT, LA 71105-4981
(318) 629-3630
(318) 629-3640
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1989088
—
LA
01
—
19D1047971
CLIA
—
Enumeration date
01/08/2007
Last updated
10/14/2008
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