MEDICARE: DR. CLARICE WEATHERS MULLINAX 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	MD0000036835	TN

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	:	1871541177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLARICE WEATHERS MULLINAX M.D.

Provider Business Mailing Address
First Line	:	2595 CENTRAL AVE
Second Line	:	CHRIST COMMUNITY HEALTH SERVICES INC
City	:	MEMPHIS
State	:	TN
Zip	:	38104-5905
Country	:	US
Telephone Number	:	901-260-8500
Fax Number	:	901-260-8590

Provider Business Practice Location Address
First Line	:	3124 NORTH THOMAS STREET
Second Line	:	CHRIST COMMUNITY HEALTH SERVICES INC
City	:	MEMPHIS
State	:	TN
Zip	:	38127
Country	:	US
Telephone Number	:	901-260-8400
Fax Number	:	901-260-8590

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	12/13/2011

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