Individual
SUPARNA MULLICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3036 CENTRE OAK WAY, GERMANTOWN, TN 38138-6302
(901) 572-0005
(901) 572-1102
Mailing address
PO BOX 758, PARIS, TN 38242-0758
(901) 572-0005
(901) 572-1102
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
49897
TN
208000000X
Pediatrics Physician
2006013531
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200382901
—
MO
Enumeration date
09/13/2006
Last updated
07/27/2022
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