Healthcare Provider Details

I. General information

NPI: 1215632377
Provider Name (Legal Business Name): TIMOTHY HOUSTON MULLICAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 E 3RD ST # 112
CHATTANOOGA TN
37403-2173
US

IV. Provider business mailing address

1201 7TH ST SE
DECATUR AL
35601-3337
US

V. Phone/Fax

Practice location:
  • Phone: 423-778-2998
  • Fax:
Mailing address:
  • Phone: 256-973-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number4629
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: