Provider Demographics
NPI:1154399947
Name:MULLINS, EMORY ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:EMORY
Middle Name:ALLEN
Last Name:MULLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-5127
Mailing Address - Country:US
Mailing Address - Phone:423-302-1350
Mailing Address - Fax:423-952-2145
Practice Address - Street 1:1490 PARK AVE NW
Practice Address - Street 2:SUITE 3
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1631
Practice Address - Country:US
Practice Address - Phone:276-679-8890
Practice Address - Fax:276-679-9740
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056009207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1154399947Medicaid
KY6466754600Medicaid
VAP00686081OtherRR MEDICARE
VA1154399947Medicaid
VAVVH167AMedicare PIN
KY6466754600Medicaid