1427511260 NPI number — JOHNNY GLENN MULLINIKS FNP, APRN

Table of content: JOHNNY GLENN MULLINIKS FNP, APRN (NPI 1427511260)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427511260 NPI number — JOHNNY GLENN MULLINIKS FNP, APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MULLINIKS
Provider First Name:
JOHNNY
Provider Middle Name:
GLENN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP, APRN
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MULLINIKS
Provider Other First Name:
JOHNNY
Provider Other Middle Name:
GLENN
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
I
Provider Other Credential Text:
FNP,APRN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1427511260
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
418 FOOT LOG LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOGANSVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30230-1145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-668-0136
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
371 NEWNAN CROSSING BYP STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWNAN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30265-3888
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-400-8410
Provider Business Practice Location Address Fax Number:
770-400-8414
Provider Enumeration Date:
04/09/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN188123 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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