Provider Demographics
NPI:1295987428
Name:MULLINS, JAMES GRAY (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GRAY
Last Name:MULLINS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W PONCE DE LEON AVE UNIT 421
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3262
Mailing Address - Country:US
Mailing Address - Phone:404-606-0172
Mailing Address - Fax:
Practice Address - Street 1:990 HAMMOND DR NE STE 575
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-9113
Practice Address - Country:US
Practice Address - Phone:404-606-0172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA778103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical