MEDICARE: DR. THOMAS N MULLEN M.D.

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	207Q00000X	Family Medicine Physician	39882	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174520837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS N MULLEN M.D.

Provider Business Mailing Address
First Line	:	738 DEODARA DR
Second Line	:
City	:	ALTADENA
State	:	CA
Zip	:	91001-2310
Country	:	US
Telephone Number	:	626-676-3797
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	08/09/2010

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