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1851887624

NPI Code Detail

MEDICARE: KEEGAN MULLINS MD

MEDICARE: KEEGAN MULLINS MD

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	207P00000X	Emergency Medicine Physician	28236	NV
2	207P00000X	Emergency Medicine Physician	80917	MN
3	208D00000X	General Practice Physician	28236	NV
4	207P00000X	Emergency Medicine Physician	17850	SD
5	207P00000X	Emergency Medicine Physician	MD-55839	IA
6	207P00000X	Emergency Medicine Physician	ME150171	FL
7	208D00000X	General Practice Physician	80917	MN
8	207P00000X	Emergency Medicine Physician	35982	MS
9	208D00000X	General Practice Physician	89262	SC
10	208D00000X	General Practice Physician	17850	SD
11	208D00000X	General Practice Physician	35982	MS
12	207P00000X	Emergency Medicine Physician	89262	SC
13	208D00000X	General Practice Physician	MD-55839	IA
14	208D00000X	General Practice Physician	14341-320	WI
15	208D00000X	General Practice Physician	ME150171	FL

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	:	1851887624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEEGAN MULLINS MD

Provider Business Mailing Address
First Line	:	58 HANOVER ST
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29403-4824
Country	:	US
Telephone Number	:	513-673-9899
Fax Number	:

Provider Business Practice Location Address
First Line	:	316 CALHOUN ST
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29401-1113
Country	:	US
Telephone Number	:	843-724-2000
Fax Number	:

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

Provider Enumeration Date	:	07/05/2018
Last Update Date	:	02/09/2026

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Directions to “ KEEGAN MULLINS MD” Practice Location

Language	Start Address	Practice Location

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