Organization
MUTIGEN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARCUS WILLIAM LEE (OWNER/CEO)
(931) 455-2273
Entity
Organization
Contact information
Practice address
711 N ATLANTIC ST, TULLAHOMA, TN 37388
(931) 967-2681
Mailing address
PO BOX 1900, TULLAHOMA, TN 37388-1900
(993) 131-4559
(931) 563-7659
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
MD35884
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1457364077
INDIVIDUAL NPI
TN
Enumeration date
04/07/2008
Last updated
10/01/2024
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