Healthcare Provider Details

I. General information

NPI: 1073558516
Provider Name (Legal Business Name): LEE ASHLEY MULLINAX MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 DOCTORS DR
GREENVILLE SC
29605-5622
US

IV. Provider business mailing address

1 INDEPENDENCE PT STE 212
GREENVILLE SC
29615-4536
US

V. Phone/Fax

Practice location:
  • Phone: 864-797-7100
  • Fax: 864-797-7105
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number29450
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: