Individual
MR. JONATHAN T MULLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1062 FORSYTH ST STE 2D, MACON, GA 31201-8639
(478) 633-8391
Mailing address
1062 FORSYTH ST STE 2D, MACON, GA 31201-8639
(478) 633-8391
(478) 633-8395
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
005099
GA
363AM0700X
Medical Physician Assistant
005099
GA
Other
Enumeration date
07/19/2007
Last updated
12/04/2024
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