Provider Demographics
NPI:1275682965
Name:MULLENIX, JASON BRYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:BRYAN
Last Name:MULLENIX
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 1:8110 N BROTHER BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-2760
Mailing Address - Country:US
Mailing Address - Phone:901-255-5221
Mailing Address - Fax:901-373-4511
Practice Address - Street 1:8110 N BROTHER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-2760
Practice Address - Country:US
Practice Address - Phone:901-373-9221
Practice Address - Fax:901-202-5995
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD39627207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09059737Medicaid
TN4293918OtherBCBS
TN3334852Medicaid
TN3334852Medicaid
TN103I161708Medicare PIN