Individual
THEODORE MCMULLEN III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
616 19TH ST, COLUMBUS, GA 31901-1528
(706) 494-4262
Mailing address
1509 PINE TREE PL, BIRMINGHAM, AL 35235-2802
(706) 494-4262
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN186965
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
073260
AANA CERT
GA
Enumeration date
11/20/2006
Last updated
10/06/2007
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