Provider Demographics
NPI:1831979392
Name:MULLINS, RICHARD EDWARD (PHD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:EDWARD
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 1:2857 INDIAN SHOALS RD
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-1835
Mailing Address - Country:US
Mailing Address - Phone:770-712-2230
Mailing Address - Fax:
Practice Address - Street 1:8551 N 125TH EAST AVE STE 150
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-2296
Practice Address - Country:US
Practice Address - Phone:833-272-5227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007-005247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician