Provider Demographics
NPI:1659469690
Name:MULLINS, GINGER DANIELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:DANIELLE
Last Name:MULLINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4976 ALPHA LN
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5470
Mailing Address - Country:US
Mailing Address - Phone:423-497-5355
Mailing Address - Fax:423-308-0281
Practice Address - Street 1:1700 BROAD ST STE 140
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37408-1834
Practice Address - Country:US
Practice Address - Phone:423-493-5240
Practice Address - Fax:423-493-5241
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1386363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1386OtherPHYSICAN ASSISTANT LICENS
TN3668711Medicare PIN