Healthcare Provider Details

I. General information

NPI: 1265451074
Provider Name (Legal Business Name): LAURA B MULLINS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 CROSSGATES DR W
BRANDON MS
39042-2233
US

IV. Provider business mailing address

1405 CROSSGATES DR W
BRANDON MS
39042-2233
US

V. Phone/Fax

Practice location:
  • Phone: 601-825-0925
  • Fax: 601-825-6135
Mailing address:
  • Phone: 601-825-0925
  • Fax: 601-825-6135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number19247
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: