Jack Harold Mills Sr., R.PH
Individual provider Active NPI Pharmacist · Donalsonville, GA
NPI 1346348653 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1346348653
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 009642 (GA)
- Practice address
- 803 N Wiley Ave
Donalsonville, GA 39845-1121 - Phone
- (229) 524-2313
- Fax
- (229) 524-1202
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 009642 | GA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 009642 | GA | Yes |
Addresses
Primary practice location
803 N Wiley Ave
Donalsonville, GA 39845-1121
Mailing address
PO Box 232
5111 Mills Rd.
Donalsonville, GA 39845-0232
Phone (229) 524-2313
Other providers in Donalsonville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.