Provider Demographics
NPI:1578779237
Name:MULLINS, ERIC L
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:L
Last Name:MULLINS
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 1:3802 COVERED BRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-2062
Mailing Address - Country:US
Mailing Address - Phone:678-450-5962
Mailing Address - Fax:
Practice Address - Street 1:24 ALICIA LN
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1612
Practice Address - Country:US
Practice Address - Phone:706-867-0514
Practice Address - Fax:706-867-0533
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000011614183500000X
GA0209941835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No183500000XPharmacy Service ProvidersPharmacist