Individual provider Active NPI

Debra Q Mills, M.D.

  • Pediatrics Physician
  • Johnson City, TN
National Provider Identifier
1467447367
Registry record updated Jan 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD27141 Issued in TN
Practice address
325 N State of Franklin Rd
Ground FL
Johnson City, TN 37604-6062
Phone
(423) 439-7320
Fax
(423) 439-7343
NPI assigned
Sep 16, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD27141 TN Primary

Addresses

Primary practice location

325 N State of Franklin Rd
Ground FL
Johnson City, TN 37604-6062

Mailing address

PO Box 699
Mountain Home, TN 37684-0699
Phone (423) 439-7320

Other identifiers 1

IdentifierTypeStateIssuer
1509013MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080605000840 TN Practitioner - Pediatric Medicine 8123198843 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD27141TNMDPediatrics Physician
27141TNMDOccupational Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Education Assistance Corporation Pediatrics CurrentSince Jan 18, 2010 Accepting new patients
Mountain States Health Alliance Past Accepting new patients

Locations

325 N State of Franklin Rd
Johnson City, TN 37604
Phone (423) 439-7280

400 E State of Franklin Rd
Johnson City, TN 37601
Phone (423) 433-6200

222 E Main St
Johnson City, TN 37604
Phone (423) 433-6200

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705968000000",
    "number": "1467447367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 699",
            "city": "MOUNTAIN HOME",
            "state": "TN",
            "postal_code": "376840699",
            "telephone_number": "423-439-7320",
            "fax_number": "423-439-7343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 N STATE OF FRANKLIN RD",
            "address_2": "GROUND FL",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046062",
            "telephone_number": "423-439-7320",
            "fax_number": "423-439-7343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLS",
        "first_name": "DEBRA",
        "middle_name": "Q",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-16",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "MD27141",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1509013",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.