Basic Information
| Provider Information | |||||||||
| NPI: | 1003148925 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLS | ||||||||
| FirstName: | JULIAN | ||||||||
| MiddleName: | DAVIS | ||||||||
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| Credential: | MT, CLT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MILLS | ||||||||
| OtherFirstName: | JULIE | ||||||||
| OtherMiddleName: | D. | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3280 PATE DR | ||||||||
| Address2: | |||||||||
| City: | SNELLVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300785021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704033794 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3280 PATE DR | ||||||||
| Address2: | |||||||||
| City: | SNELLVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300785021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704033794 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2010 | ||||||||
| LastUpdateDate: | 03/15/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | MT004927 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.