Individual
MR. JOHN WILLIAM MULLENS IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AGACNP
Contact information
Practice address
200 S ENOTA DR NE STE 100, GAINESVILLE, GA 30501-3466
(770) 534-2020
Mailing address
PO BOX 742616, ATLANTA, GA 30374-2616
(770) 219-8420
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN289159
GA
363LA2100X
Acute Care Nurse Practitioner
Primary
RN289159
GA
363LG0600X
Gerontology Nurse Practitioner
2023000291
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2023000291
AMERICAN NURSING CREDENTIALING CENTER
GA
01
—
RN289159
GEORGIA BOARD OF NURSING
GA
Enumeration date
02/13/2023
Last updated
05/24/2023
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