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General NPI Number Information
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NPI Number | 1295987428
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Entity Type | Individual
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Provider Name | JAMES GRAY MULLINS PH.D.
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Gender | Male
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 10/21/2008
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Provider Practice Location Address
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Address Line | 990 HAMMOND DR NE STE 575
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City | ATLANTA
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State | GA
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Zip | 30328-9113
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Country | US
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Telephone | 404-606-0172
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Fax |
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Provider Business Mailing Address
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Address Line | 201 W PONCE DE LEON AVE UNIT 421
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City | DECATUR
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State | GA
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Zip | 30030-3262
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Country | US
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Telephone | 404-606-0172
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 778
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License Number State | GA
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