Provider Demographics
NPI:1649540931
Name:JOHN DAVID MULLINS, MD, PC
Entity type:Organization
Organization Name:JOHN DAVID MULLINS, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:DANITA
Authorized Official - Last Name:MCKAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-355-9255
Mailing Address - Street 1:35 COLLIER RD NW STE 675
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1612
Mailing Address - Country:US
Mailing Address - Phone:404-355-9255
Mailing Address - Fax:404-355-5822
Practice Address - Street 1:35 COLLIER RD NW STE 675
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1612
Practice Address - Country:US
Practice Address - Phone:404-355-9255
Practice Address - Fax:404-355-5822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20782174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA256843211BMedicare PIN