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General NPI Number Information
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NPI Number | 1144364043
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Entity Type | Individual
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Provider Name | KENDALL CLARK MULLINS O.D.
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Gender | Male
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 9220 MARNE RD
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City | FORT MOORE
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State | GA
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Zip | 31905-5515
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Country | US
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Telephone | 706-682-3938
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Fax | 706-682-3931
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Provider Business Mailing Address
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Address Line | 70 COUNTY ROAD 941
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City | CLANTON
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State | AL
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Zip | 35045-7979
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Country | US
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Telephone | 205-585-6461
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Fax |
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | S-779-TA-718
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT001400
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License Number State | GA
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