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Individual

JERRY MULLIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2100 RIVERSIDE AVE, WAYCROSS, GA 31501-7020
(912) 490-7777
Mailing address
PO BOX 532855, ATLANTA, GA 30353-2855
(904) 805-1300
(904) 805-1302

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
42368
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000754872D
GA
05
000754872H
GA
01
100165
BLUE CROSS
GA
Enumeration date
07/26/2006
Last updated
01/14/2026
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