Provider Demographics
NPI:1124551858
Name:MULLINS, SAMANTHA JO (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:JO
Last Name:MULLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:300 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2400
Mailing Address - Country:US
Mailing Address - Phone:270-753-0704
Mailing Address - Fax:
Practice Address - Street 1:300 S 8TH ST STE 480W
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2403
Practice Address - Country:US
Practice Address - Phone:270-753-0704
Practice Address - Fax:270-752-2852
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000063197207Q00000X, 207Q00000X
KY55704207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine