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General NPI Number Information
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NPI Number | 1275805384
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Entity Type | Individual
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Provider Name | BRIAN DOUGLAS MULLIN PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/04/2012
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Last Update Date | 02/04/2012
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Provider Practice Location Address
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Address Line | 550 PEACHTREE ST NE
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City | ATLANTA
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State | GA
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Zip | 30308-2208
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Country | US
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Telephone | 404-686-2513
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Fax |
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Provider Business Mailing Address
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Address Line | 1024 ABINGDON LN
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City | JOHNS CREEK
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State | GA
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Zip | 30022-6270
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Country | US
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Telephone | 404-759-5593
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 006366
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License Number State | GA
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