Provider Demographics
NPI:1205391745
Name:MCMULLIN, JONATHAN WAYNE (OD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:WAYNE
Last Name:MCMULLIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:JON
Other - Middle Name:
Other - Last Name:MCMULLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:221 TECHNOLOGY PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1369
Mailing Address - Country:US
Mailing Address - Phone:762-235-1000
Mailing Address - Fax:
Practice Address - Street 1:550 REDMOND RD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1416
Practice Address - Country:US
Practice Address - Phone:762-235-3200
Practice Address - Fax:706-233-8503
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003664152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist