Healthcare Provider Details

I. General information

NPI: 1104856301
Provider Name (Legal Business Name): NORMA J MULLINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3771 ROBERT C BYRD DRIVE
BECKLEY WV
25801
US

IV. Provider business mailing address

PO BOX 1307
BECKLEY WV
25802-1307
US

V. Phone/Fax

Practice location:
  • Phone: 304-255-5710
  • Fax: 304-255-5702
Mailing address:
  • Phone: 304-255-5710
  • Fax: 304-255-5702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number11394
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: