Provider Demographics
NPI:1689445603
Name:MULLINS, DAVID PRINTUS (PA-C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:PRINTUS
Last Name:MULLINS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 W MORRIS BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-3866
Mailing Address - Country:US
Mailing Address - Phone:423-318-0014
Mailing Address - Fax:423-581-2616
Practice Address - Street 1:1907 W MORRIS BLVD STE G
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-3866
Practice Address - Country:US
Practice Address - Phone:423-318-0014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5742363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant