MEDICARE: MR. TIMOTHY CHRIS MULLINS ATC

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1558325134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY CHRIS MULLINS ATC

Provider Business Mailing Address
First Line	:	112 NORTHPOINTE DR.
Second Line	:
City	:	OXFORD
State	:	MS
Zip	:	38655
Country	:	US
Telephone Number	:	662-915-1841
Fax Number	:	662-915-1833

Provider Business Practice Location Address
First Line	:	1810 MANNINGWAY
Second Line	:	UNIVERSITY OF MISSISSIPPI
City	:	UNIVERSITY
State	:	MS
Zip	:	38677
Country	:	US
Telephone Number	:	662-915-1841
Fax Number	:

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

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	07/08/2007

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