Provider Demographics
NPI:1902433485
Name:MILLS, MARY PATE (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:PATE
Last Name:MILLS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:745 THORNBERRY DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-4873
Mailing Address - Country:US
Mailing Address - Phone:770-853-4190
Mailing Address - Fax:
Practice Address - Street 1:6918 MCGINNIS FERRY RD STE 200
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1258
Practice Address - Country:US
Practice Address - Phone:770-622-5758
Practice Address - Fax:770-622-5717
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA94206208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208000000XAllopathic & Osteopathic PhysiciansPediatrics