Provider Demographics
NPI:1841525227
Name:MULLANEY, STEPHEN (APN)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:MULLANEY
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:STEPHEN
Other - Middle Name:M
Other - Last Name:MULLANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 935722
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-5722
Mailing Address - Country:US
Mailing Address - Phone:843-792-6200
Mailing Address - Fax:
Practice Address - Street 1:2601 LAUREL ST STE 130
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2035
Practice Address - Country:US
Practice Address - Phone:803-227-5320
Practice Address - Fax:803-227-5326
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18311363LF0000X
IL209007692363LF0000X
IL209.007692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2531Medicaid
IL209.007692Medicaid