Provider Demographics
NPI:1962477950
Name:MULL, MICHAEL S (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:MULL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:699 CHURCH ST NE
Mailing Address - Street 2:STE 220
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1116
Mailing Address - Country:US
Mailing Address - Phone:770-422-8505
Mailing Address - Fax:770-424-7449
Practice Address - Street 1:699 CHURCH ST NE
Practice Address - Street 2:STE 220
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1116
Practice Address - Country:US
Practice Address - Phone:770-422-8505
Practice Address - Fax:770-424-7449
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2016-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA025804207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA323482OtherWELLCARE
GA0700267OtherUNITED HEALTHCARE
FL151069OtherBCBS
GA4031243OtherAETNA
GA00279914AMedicaid
GA00279914DMedicaid
GA1766086-002OtherCIGNA
GA00279914BMedicaid
GA10056243OtherAMERIGROUP
GA00279914BMedicaid
GA00279914BMedicaid