Healthcare Provider Details

I. General information

NPI: 1174597843
Provider Name (Legal Business Name): RICHARD LEE MULLINS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 E SOUTH BLVD SUITE 601
MONTGOMERY AL
36116-2001
US

IV. Provider business mailing address

301 BROWN SPRINGS RD
MONTGOMERY AL
36117-7005
US

V. Phone/Fax

Practice location:
  • Phone: 334-747-2999
  • Fax: 334-747-7276
Mailing address:
  • Phone: 334-747-4159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME94362
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number30078
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: