Healthcare Provider Details

I. General information

NPI: 1437107109
Provider Name (Legal Business Name): MARK MULLINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE
ATLANTA GA
30322
US

IV. Provider business mailing address

1364 CLIFTON RD NE
ATLANTA GA
30322
US

V. Phone/Fax

Practice location:
  • Phone: 404-712-4583
  • Fax: 404-712-7957
Mailing address:
  • Phone: 404-712-7033
  • Fax: 404-712-7970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number056588
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: