Provider Demographics
NPI:1033422340
Name:MULLNER, JUSTIN ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:ANDREW
Last Name:MULLNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1215
Mailing Address - Country:US
Mailing Address - Phone:803-434-6116
Mailing Address - Fax:803-434-8545
Practice Address - Street 1:3209 COLONIAL DRIVE
Practice Address - Street 2:FAMILY MEDICINE DEPARTMENT
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-434-6116
Practice Address - Fax:803-434-8545
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME148244207QS0010X
SCLL32987207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine