Healthcare Provider Details

I. General information

NPI: 1962569335
Provider Name (Legal Business Name): NATHAN HALE MULL, IV, MD., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 CRYE LEIKE DR
FT OGLETHORPE GA
30742-4055
US

IV. Provider business mailing address

83 CRYE LEIKE DR
FT OGLETHORPE GA
30742-4055
US

V. Phone/Fax

Practice location:
  • Phone: 706-866-7762
  • Fax: 423-495-7887
Mailing address:
  • Phone: 706-866-7762
  • Fax: 423-495-7887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number46626
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number46626
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number46626
License Number StateGA

VIII. Authorized Official

Name: DR. NATHAN H MULL IV
Title or Position: OWNER
Credential: MD
Phone: 706-866-7762