Provider Demographics
NPI:1912109042
Name:MULLINS, JEREMY D (MS RD)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:D
Last Name:MULLINS
Suffix:
Gender:M
Credentials:MS RD
Other - Prefix:
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Mailing Address - Street 1:101 29TH ST SE
Mailing Address - Street 2:UNIT 15
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1149
Mailing Address - Country:US
Mailing Address - Phone:304-347-4313
Mailing Address - Fax:304-347-4316
Practice Address - Street 1:MEDABOLIX INC 600 TRACY WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311
Practice Address - Country:US
Practice Address - Phone:304-347-4313
Practice Address - Fax:304-347-4316
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered