Provider Demographics
NPI:1043722754
Name:NATHAN H MULL IV LLC
Entity Type:Organization
Organization Name:NATHAN H MULL IV LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:MULL
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:423-821-3866
Mailing Address - Street 1:PO BOX 80033
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37414-7033
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 SYLVAN DR
Practice Address - Street 2:
Practice Address - City:LOOKOUT MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37350-1630
Practice Address - Country:US
Practice Address - Phone:423-821-3866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty