Provider Demographics
NPI:1841617602
Name:MULLINS, RODNEY A (NP)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:A
Last Name:MULLINS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 MIMOSA DR
Mailing Address - Street 2:STE 1R
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6678
Mailing Address - Country:US
Mailing Address - Phone:912-644-5300
Mailing Address - Fax:912-644-5260
Practice Address - Street 1:1622 MADISON AVE
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3756
Practice Address - Country:US
Practice Address - Phone:229-389-8061
Practice Address - Fax:229-387-8064
Is Sole Proprietor?:No
Enumeration Date:2014-03-18
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN196567363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily