Provider Demographics
NPI:1689725608
Name:MULLIGAN, CAROL M (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:M
Last Name:MULLIGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3330
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30914-3330
Mailing Address - Country:US
Mailing Address - Phone:803-278-2473
Mailing Address - Fax:803-278-2473
Practice Address - Street 1:7208 HODGSON MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2512
Practice Address - Country:US
Practice Address - Phone:803-278-2473
Practice Address - Fax:803-278-2473
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2016-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026003207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA581638217OtherTAX ID
GA000276284CMedicaid
GAD30137Medicare UPIN
GA581638217OtherTAX ID