Healthcare Provider Details

I. General information

NPI: 1043722754
Provider Name (Legal Business Name): NATHAN H MULL IV LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2017
Last Update Date: 11/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SYLVAN DR
LOOKOUT MOUNTAIN TN
37350-1630
US

IV. Provider business mailing address

PO BOX 80033
CHATTANOOGA TN
37414-7033
US

V. Phone/Fax

Practice location:
  • Phone: 423-821-3866
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NATHAN H MULL IV
Title or Position: OWNER
Credential:
Phone: 423-821-3866