Healthcare Provider Details

I. General information

NPI: 1790023406
Provider Name (Legal Business Name): DONNA SUE MULLER M.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2013
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 COSMOS DR NE
ATLANTA GA
30345-1307
US

IV. Provider business mailing address

2715 COSMOS DR NE
ATLANTA GA
30345-1307
US

V. Phone/Fax

Practice location:
  • Phone: 770-938-3304
  • Fax:
Mailing address:
  • Phone: 770-938-3304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number027615
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: