Healthcare Provider Details

I. General information

NPI: 1841617602
Provider Name (Legal Business Name): RODNEY A MULLINS NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2014
Last Update Date: 05/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 MADISON AVE
TIFTON GA
31794-3756
US

IV. Provider business mailing address

100 MIMOSA DR STE 1R
THOMASVILLE GA
31792-6678
US

V. Phone/Fax

Practice location:
  • Phone: 229-389-8061
  • Fax: 229-387-8064
Mailing address:
  • Phone: 912-644-5300
  • Fax: 912-644-5260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN196567
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: