Provider Demographics
NPI:1245202035
Name:MULLIS, DANIEL ASHLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ASHLEY
Last Name:MULLIS
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 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:707-718-1122
Mailing Address - Fax:770-535-4786
Practice Address - Street 1:725 JESSE JEWELL PKWY SE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3834
Practice Address - Country:US
Practice Address - Phone:770-718-1122
Practice Address - Fax:770-535-7445
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26933208600000X
GA060414208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA01162479OtherAMERIGROUP
GA429270OtherWELLCARE
GA530057171AMedicaid
GA52162699OtherBCBS
GA530057171BMedicaid
GA9223107OtherAETNA
GAP00633303OtherMEDICARE RAILROAD
GA2448767OtherUNITED HEALTHCARE
GA4066030OtherCIGNA
SCP00219012OtherRAILROAD MEDICARE
GA530057171DMedicaid
SC269337Medicaid
GA530057171CMedicaid
GA9223107OtherAETNA
GA429270OtherWELLCARE
GA530057171CMedicaid