MEDICARE: MULLEN ELDER CARE, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	039882	GA

General Provider Information

NPI Number	:	1083882435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MULLEN ELDER CARE, P.C.

Provider Business Mailing Address
First Line	:	126 SEQUOYAH TRL
Second Line	:
City	:	RINGGOLD
State	:	GA
Zip	:	30736-4360
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	126 SEQUOYAH TRL
Second Line	:
City	:	RINGGOLD
State	:	GA
Zip	:	30736-4360
Country	:	US
Telephone Number	:	706-965-2179
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS MULLEN
Credential	:	MD
Telephone Number	:	706-965-2179

Provider Enumeration Date	:	02/19/2008
Last Update Date	:	02/19/2008

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