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General NPI Number Information
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NPI Number | 1033249057
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Entity Type | Individual
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Provider Name | BANDY B MULLINS MD
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Gender | Male
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 04/21/2022
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Provider Practice Location Address
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Address Line | 400 FAIRVIEW HEIGHTS RD
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City | SUMMERSVILLE
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State | WV
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Zip | 26651-9308
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Country | US
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Telephone | 304-872-8404
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Fax | 304-872-0409
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Provider Business Mailing Address
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Address Line | 400 FAIRVIEW HEIGHTS RD
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City | SUMMERSVILLE
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State | WV
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Zip | 26651-9308
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Country | US
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Telephone | 304-872-8404
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Fax | 304-872-0409
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 22570
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License Number State | WV
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