Provider Demographics
NPI:1124011747
Name:MULLINS, CALVIN JEFFREY (MD)
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:JEFFREY
Last Name:MULLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 UNION AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6655
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8115 COUNTRY VILLAGE DR
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-2030
Practice Address - Country:US
Practice Address - Phone:901-752-2300
Practice Address - Fax:901-752-2348
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21895207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2598526OtherCIGNA
TN4344850OtherBCBS
TN140377OtherUNITED HEALTHCARE
TN4235847OtherAETNA
TN140377OtherUNITED HEALTHCARE
TN103I089975Medicare PIN