Millsaps was born in Knoxville, Tennessee and grew up in Cobb County, Georgia where he attended McEachern High School. He received his bachelor's degree in psychology from Samford University in 1995, where he graduated cum laude. After receiving his undergraduate degree, Millsaps worked for the Georgia Republican Party and then served as the political director for Johnny Isakson's first campaign for the U.S. Senate, which ended in a primary loss in 1996.
He enrolled in the University of Georgia School of Law in 1997. While still in law school, Millsaps served as the Policy Advisor to the Georgia State School Board and acted as the liaison between the Board Chairman Otis Brumby, then Georgia Governor Roy Barnes and then State School Superintendent Linda Schrenko. Millsaps obtained his Juris Doctor in 2000. After law school, he resumed a limited involvement in politics, organizing events and advising candidates for state and local offices.
After passing the Georgia bar in 2000, he worked for criminal defense attorneys Ed Garland and Don Samuel during high-profile cases involving Ray Lewis, the Heritage High School shooting and the Gold Club trial. He continued his early legal career as a litigator and later practiced law with his mentor, Hylton B. Dupree, Jr.
Millsaps founded his own law firm in 2004, which merged in 2011 with Hall Booth Smith where he was partner. Millsaps represented the Georgia Department of Community Health in 2008 as Special Counsel to Governor Sonny Perdue. In 2010, Millsaps obtained a $1.5 million jury verdict for the family of a man that was killed by a drunk driver. This was one of the top jury verdicts in Georgia in 2010.
In 2001, six months after he received his bar license, Millsaps filed the first lawsuit on behalf of a charter school against a school district in the state of Georgia. Millsaps represented Stone Mountain Charter School in a lawsuit against the Dekalb County school board over funding which the school claimed it should have and did not receive. The suit's premise was that the Dekalb school board was discriminating against the charter school and breaching the charter school contract by allotting less money per student than other schools in the district. The school board paid to settle the suit, though it denied any wrongdoing, citing the 1998 charter school law that did not provide guidelines for funding.
On December 26, 2011, Millsaps was contacted by Newt Gingrich's 2012 campaign for the Republican nomination for president to offer him a position as deputy general counsel—a volunteer position. Millsaps joined the campaign, his first involvement working in a presidential race, the week before the Iowa caucuses.
After a month working for the campaign, and orchestrating Gingrich's primary win in South Carolina, Gingrich promoted Millsaps to the position of chief of staff following the Florida primary and immediately made changes to reorganize the campaign's structure. In February 2012, he wrote a cease and desist letter sent to Georgia television stations on behalf of the Gingrich campaign, stating that an attack ad made by pro-Mitt Romney super PAC, Restore Our Future, was false and threatening to sue any station that continued to run the ad. The ad asserted that Gingrich co-sponsored legislation with Representative Nancy Pelosi that would have given money to the United Nations in support of China's one-child policy. While Gingrich and Pelosi were both co-sponsors of a 1989 resolution that provided $60 million to the United Nations Population Fund, the bill prohibited "the performance of involuntary sterilization or abortion or to coerce any person to accept family planning".
Gingrich credits Millsaps with his statement, "you can't put a gun rack in a Volt". Millsaps was also the designer of the "$2.50 gas" logo for Gingrich's campaign, which was part of an effort to simplify the campaign's messaging. Millsaps gave several national television and radio interviews for the campaign including interviews with CNN's Joe Johns, Don Lemon, Jim Acosta, and Piers Morgan. He also appeared on MSNBC with Thomas Roberts and Andrea Mitchell.
Gingrich suspended his campaign for president on May 2, 2012.
The first film Millsaps executive produced was I'll See You in My Dreams, starring Blythe Danner, Martin Starr, Sam Elliott, Malin Åkerman, June Squibb and Rhea Perlman, which was selected to premiere at the 2015 Sundance Film Festival. The film was purchased for distribution by Bleecker Street and premiered in New York and Los Angeles on the weekend of May 15, 2015 to rave reviews.
In December 2015, Millsaps founded Londonderry Entertainment, a talent management and production company. Early in 2016, Millsaps restructured his company with Londonderry becoming the parent company of three subsidiaries: Londonderry Films (a film finance and production company); Londonderry Tales (a television and digital media finance and production company); and Osquared (a targeted film marketing company.)
Millsaps is now executive producing the film Wild Man, starring Kate Upton, Mike Vogel and Christine Woods. The film is co-directed by Stefanie Black and Jacquie Phillips.
Millsaps was a vocal critic of the Georgia General Assembly's so-called "Religious Liberty" bill and warned of its impact on Georgia's economy. Georgia Governor Nathan Deal vetoed the controversial piece of legislation.
Actor Steve Guttenberg said of Millsaps, "His work ethic is one that combines strategy, enthusiasm, and humor... But the most defining aspect of him is his perspective on the film and television community and business as a whole. He finds the game a challenge and approaches it with a positive attitude." It has also been said of him that "he is loyal and he has the highest integrity (in show business) which could mean everything or nothing at all".
In 2009, Georgia Governor Sonny Perdue signed the first tax incentive bill to encourage film and television production in the state of Georgia. As of July, 2015, these incentives had generated $6 billion in economic impact in Georgia. Governor Perdue credited Millsaps for ensuring that these incentives were passed in Georgia, stating, "Patrick Millsaps understood early the benefits for Georgia aggressively pursuing the entertainment industry as an economic development project." "The combination of his business, political and legal skills were helpful in making tax credits a reality in Georgia."
Millsaps has been called "one of the smartest, hard-working lawyers in the country". He has achieved an "AV-Preeminent" rating from Martindale-Hubbell. Millsaps was recognized by Georgia Trend Magazine as one of Georgia's best and brightest "40 under 40" in 2011. James Magazine has recognized him as one of the "Most Influential Georgians" every year since 2007, and one of "Georgia's Top Legal Leaders" in 2005 and 2006. The University of Georgia's Alumni Association recognized him as one of its 40 Under 40 in 2012. Atlanta Magazine recognized Millsaps as a "Rising Star" in 2010 and 2012. He was named one of as one of Southwest Georgia's "40 most influential people under the age of 40" by The Albany Herald in 2006.
In 2008, Millsaps was selected as one of 53 emerging American leaders representing 17 states and the District of Columbia to receive the prestigious Marshall Memorial Fellowship awarded through the German Marshall Fund.
Millsaps has appeared in several feature films. He played a police officer in the 2000 DreamWorks film Road Trip. He also appears in the 2011 Sherwood Pictures film Courageous as "man in restaurant." In 2012, Millsaps received his first credited role, as District Attorney Denny Donaldson in the independent film Untouched.
In the wake of the May, 2017 bombing at an Ariana Grande concert in Manchester, England, Millsaps penned on open letter to Miss Grande that went viral globally. After sharing the letter on Twitter, it has been viewed millions of times and shared over 100,000 times and liked by pop stars Taylor Swift, Miley Cyrus, Nicki Minaj and Grande herself. Millsaps' letter received worldwide media attention and was covered by Mashable, the Today Show, BuzzFeed, BBC, the Daily Mail, Cosmopolitan, USA Today, MTV, the New York Daily News, Fox News, and thousands of other online, radio, print and television outlets.