Provider Demographics
NPI:1326003591
Name:MULLIS, JAMES MICHAEL
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:MULLIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 JERRY WAHL RD
Mailing Address - Street 2:
Mailing Address - City:CHAUNCEY
Mailing Address - State:GA
Mailing Address - Zip Code:31011-3761
Mailing Address - Country:US
Mailing Address - Phone:478-374-3211
Mailing Address - Fax:
Practice Address - Street 1:710 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-6736
Practice Address - Country:US
Practice Address - Phone:478-374-5514
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA18615183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA73BBBCWMedicare ID - Type UnspecifiedFLU IMMUNIZATIONS