MEDICARE: DR. ANGELYNNE AMICK MCMULLAN PH.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	103TB0200X	Cognitive & Behavioral Psychologist	603	AL

General Provider Information

NPI Number	:	1497811798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELYNNE AMICK MCMULLAN PH.D.

Provider Business Mailing Address
First Line	:	300 VESTAVIA OFFICE PARK
Second Line	:	SUITE 3200
City	:	BIRMINGHAM
State	:	AL
Zip	:	35216-3753
Country	:	US
Telephone Number	:	205-822-7348
Fax Number	:	205-822-7297

Provider Business Practice Location Address
First Line	:	300 VESTAVIA OFFICE PARK
Second Line	:	SUITE 3200
City	:	BIRMINGHAM
State	:	AL
Zip	:	35216-3753
Country	:	US
Telephone Number	:	205-822-7348
Fax Number	:	205-822-7297

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	07/08/2007

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