Active NPI
Kellie Brandenburg Mullins, PT
- Physical Therapist
- Jefferson, GA
National Provider Identifier
1033245188
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT005956
- Practice address
- 116 Chickasaw TRL
Jefferson, GA 30549-6346 - Phone
- (678) 794-1182
- Fax
- (706) 387-7575
- NPI assigned
- Feb 25, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT005956 | GA | Primary |
Addresses
Primary practice location
116 Chickasaw TRL
Jefferson, GA 30549-6346
Mailing address
116 Chickasaw TRL
Jefferson, GA 30549-6346
Phone (678) 794-1182
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT005956 | GA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1033245188",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "116 CHICKASAW TRL",
"city": "JEFFERSON",
"state": "GA",
"postal_code": "305496346",
"telephone_number": "678-794-1182",
"fax_number": "706-387-7575"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "116 CHICKASAW TRL",
"city": "JEFFERSON",
"state": "GA",
"postal_code": "305496346",
"telephone_number": "678-794-1182",
"fax_number": "706-387-7575"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULLINS",
"first_name": "KELLIE",
"middle_name": "BRANDENBURG",
"name_prefix": "Mrs.",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "GA",
"license": "PT005956",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jefferson, GA
- Annette Raquel McMichael, CSFA
- Medlink Georgia Inc (MedLink Jefferson)
- Milestone Pediatric Therapy Services, Inc.
- Nathalie Mize, RN
- MP Dental, LLC (Jefferson Dental Care)
- Molly Musselwhite, PA-C
- William Robert Newell, DMD, PC
- Noah's Ark Homecare, Inc.
- Northeast Georgia Surgical Assisting
- Lauren Brennan Norwood, M.ED. CCC-SLP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.