Provider Demographics
NPI:1124011747
Name:MULLINS, CALVIN JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:CALVIN
Middle Name:JEFFREY
Last Name:MULLINS
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:PO BOX 1000
Mailing Address - Street 2:DEPT # 978
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-516-0881
Mailing Address - Fax:901-516-0528
Practice Address - Street 1:7655 POPLAR AVE
Practice Address - Street 2:BLDG A, SUITE 340
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3957
Practice Address - Country:US
Practice Address - Phone:901-752-2300
Practice Address - Fax:901-516-1399
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD21895207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2598526OtherCIGNA
TN140377OtherUNITED HEALTHCARE
TN4344850OtherBCBS
TN4235847OtherAETNA
TN140377OtherUNITED HEALTHCARE
TN103I089975Medicare PIN