Individual
THOMAS SHANE MCMULLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RD
Contact information
Practice address
353 HIGHWAY 15 N, PONTOTOC, MS 38863-1103
(662) 490-1985
(662) 490-1989
Mailing address
PO BOX 497, AUGUSTA, AR 72006-0497
(870) 347-2534
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D-2456
MS
Other
Enumeration date
10/16/2023
Last updated
10/16/2023
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