Provider Demographics
NPI:1477975654
Name:MULL FOUNDATION
Entity Type:Organization
Organization Name:MULL FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MULL
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:901-314-8701
Mailing Address - Street 1:6796 BLUE LAKE LN
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38141-0582
Mailing Address - Country:US
Mailing Address - Phone:901-314-8701
Mailing Address - Fax:
Practice Address - Street 1:6796 BLUE LAKE LN
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38141-0582
Practice Address - Country:US
Practice Address - Phone:901-314-8701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare