Provider Demographics
NPI:1427187004
Name:MULL, COURTNEY DAWN (MD)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:DAWN
Last Name:MULL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 602373
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2373
Mailing Address - Country:US
Mailing Address - Phone:828-250-2833
Mailing Address - Fax:828-250-2932
Practice Address - Street 1:472 RANKIN DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-6568
Practice Address - Country:US
Practice Address - Phone:828-652-1400
Practice Address - Fax:828-250-2740
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC121499207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907564Medicaid
NCAC5385578R824OtherDEA
NC2327875Medicare PIN