Individual
MIA MCMULLEN MCMULLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
3760 LAVISTA ROAD, SUITE 102, TUCKER, GA 30084
(404) 248-0415
(404) 248-0422
Mailing address
3318 ROYAL SPRINGS CT, DECATUR, GA 30034-7107
(404) 248-0415
(404) 248-0422
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4932
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00899346A
—
GA
Enumeration date
12/28/2006
Last updated
07/08/2007
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