Healthcare Provider Details

I. General information

NPI: 1396279550
Provider Name (Legal Business Name): AARON MITCHELL MULLANE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2017
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 LEIGH DR
COLUMBUS MS
39705-3014
US

IV. Provider business mailing address

670 LEIGH DR
COLUMBUS MS
39705-3014
US

V. Phone/Fax

Practice location:
  • Phone: 662-328-1012
  • Fax: 662-328-1507
Mailing address:
  • Phone: 626-328-1012
  • Fax: 662-328-1507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number29669
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: