Provider Demographics
NPI:1750559837
Name:MULKEYU, PHYLLIS WRIGHT (APRN-BC)
Entity type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:WRIGHT
Last Name:MULKEYU
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 TERRELL DR
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-3727
Mailing Address - Country:US
Mailing Address - Phone:404-219-9399
Mailing Address - Fax:
Practice Address - Street 1:3037 LORIDAN WAY SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5710
Practice Address - Country:US
Practice Address - Phone:404-219-9399
Practice Address - Fax:678-305-0792
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN045454 NP363LG0600X
GARN045454NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology