Provider Demographics
NPI:1962569335
Name:NATHAN HALE MULL, IV, MD., PC
Entity type:Organization
Organization Name:NATHAN HALE MULL, IV, MD., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:MULL
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:706-866-7762
Mailing Address - Street 1:83 CRYE LEIKE DR
Mailing Address - Street 2:
Mailing Address - City:FT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-4055
Mailing Address - Country:US
Mailing Address - Phone:706-866-7762
Mailing Address - Fax:423-495-7887
Practice Address - Street 1:83 CRYE LEIKE DR
Practice Address - Street 2:
Practice Address - City:FT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-4055
Practice Address - Country:US
Practice Address - Phone:706-866-7762
Practice Address - Fax:423-495-7887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA46626207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1588653208OtherNPI NUMBER