Individual
DR. BENNY CARROLL MULLINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
340 BAGLEY CIR, MARION, VA 24354-3126
(276) 783-1201
Mailing address
15698 MONTICELLO DR, BRISTOL, VA 24202-4110
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
0101025318
VA
207Q00000X
Family Medicine Physician
Primary
0101025318
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134141401
—
VA
05
—
64919186
—
KY
01
—
EIN CO2259
EIN
VA
Enumeration date
07/24/2006
Last updated
03/25/2011
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