Healthcare Provider Details

I. General information

NPI: 1881628998
Provider Name (Legal Business Name): CHARLES ANDREW MULLINS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 01/19/2022
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2557 HIGHWAY 41 S
GREENBRIER TN
37073-5516
US

IV. Provider business mailing address

2557 HIGHWAY 41 S
GREENBRIER TN
37073-5516
US

V. Phone/Fax

Practice location:
  • Phone: 615-643-4534
  • Fax: 615-643-4537
Mailing address:
  • Phone: 615-643-4534
  • Fax: 615-643-4537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO-717
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3608
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: