Individual
MR. BENNIE JOE MULLINS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1755 HIGHWAY 34 E, SUITE 1100, NEWNAN, GA 30265-5631
(770) 251-2060
Mailing address
PO BOX 73709, NEWNAN, GA 30271-3709
(770) 251-2060
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2004036293
MO
367500000X
Certified Registered Nurse Anesthetist
RN113064
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
917249500
—
MO
Enumeration date
11/15/2005
Last updated
05/03/2023
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