Individual
DEIDRE MILLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
610 19TH ST, COLUMBUS, GA 31901-1528
(706) 322-7884
Mailing address
610 19TH ST, COLUMBUS, GA 31901-1528
(706) 322-7884
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN166187
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
056655363
DRIVERS LICENSE NUMBER
GA
Enumeration date
08/06/2015
Last updated
08/06/2015
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