Provider Demographics
NPI:1427511260
Name:MULLINIKS, JOHNNY GLENN (FNP, APRN)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:GLENN
Last Name:MULLINIKS
Suffix:
Gender:M
Credentials:FNP, APRN
Other - Prefix:MR
Other - First Name:JOHNNY
Other - Middle Name:GLENN
Other - Last Name:MULLINIKS
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:FNP,APRN
Mailing Address - Street 1:418 FOOT LOG LN
Mailing Address - Street 2:
Mailing Address - City:HOGANSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30230-1145
Mailing Address - Country:US
Mailing Address - Phone:706-668-0136
Mailing Address - Fax:
Practice Address - Street 1:371 NEWNAN CROSSING BYP STE 103
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-3888
Practice Address - Country:US
Practice Address - Phone:770-400-8410
Practice Address - Fax:770-400-8414
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN188123363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily