Healthcare Provider Details

I. General information

NPI: 1649709692
Provider Name (Legal Business Name): DONNA LYNN-FEWELL MULLNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MUSC DEPARTMENT SURGERY 30 COURTENAY DRIVE MSC 613
CHARLESTON SC
29425-8905
US

IV. Provider business mailing address

PO BOX 751461
CHARLOTTE NC
28275-1461
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-1414
  • Fax:
Mailing address:
  • Phone: 843-792-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number95191
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: