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General NPI Number Information
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NPI Number | 1962038067
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Entity Type | Individual
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Provider Name | EARL NICHOLAS MULLIS III MD
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Gender | Male
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Dates
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Enumeration Date | 03/20/2020
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Last Update Date | 11/24/2024
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Provider Practice Location Address
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Address Line | 101 E WOOD ST
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City | SPARTANBURG
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State | SC
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Zip | 29303-3040
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Country | US
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Telephone | 864-560-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 222 GROVE RD
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City | GREENVILLE
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State | SC
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Zip | 29605-4014
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Country | US
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Telephone | 478-951-3889
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 91114
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 96015
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License Number State | GA
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