Basic Information
| Provider Information | |||||||||
| NPI: | 1235157744 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLS | ||||||||
| FirstName: | COUNCIL | ||||||||
| MiddleName: | CLAYTON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5410 MARYLAND WAY SUITE 300 | ||||||||
| Address2: | COGENT HEALTHCARE | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153775658 | ||||||||
| FaxNumber: | 6153735280 | ||||||||
| Practice Location | |||||||||
| Address1: | 2670 E 29TH ST STE A | ||||||||
| Address2: | COGENT HEALTHCARE OF TEXAS, PA | ||||||||
| City: | BRYAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 778022501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9797765967 | ||||||||
| FaxNumber: | 9797744849 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 02/23/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | E6523 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | E6523 | 01 | TX | STATE | OTHER | 8CB434 | 01 | TX | BCBS | OTHER | 114274704 | 05 | TX | MEDICAID |