Mullick Dermatology, PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MD49897 Issued in TN

Legal business name

MULLICK DERMATOLOGY, PLLC

Practice address

3036 Centre Oak Way
Germantown, TN 38138-6302

Phone

(901) 572-0005

NPI assigned

Mar 9, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Suparna Mullick, M.D.NPI 1366547713

Title

President

Phone

(901) 572-0005

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Suparna Mullick, MD

  • Dermatology Physician
  • Germantown, TN
  • NPI 1366547713
  Medicare reassignment Care Compare group NPD Authorized official
• Whitney Stroud, NP

  • Nurse Practitioner
  • Germantown, TN
  • NPI 1699059667
  Medicare reassignment Care Compare group NPD
• Holly Monroe Wright, MD

  • Dermatology Physician
  • Germantown, TN
  • NPI 1659662294
  NPD (past)
• Matthew Robert Lyons, M.D.

  • Cardiovascular Disease Physician
  • Hermiston, OR
  • NPI 1558429522
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1489017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658880000000",
    "number": "1154862217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 758",
            "city": "PARIS",
            "state": "TN",
            "postal_code": "382420758",
            "telephone_number": "901-572-0005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3036 CENTRE OAK WAY",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381386302",
            "telephone_number": "901-572-0005"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9760 Lipsey Cv",
            "address_purpose": "LOCATION",
            "city": "Germantown",
            "state": "TN",
            "postal_code": "381398076",
            "country_code": "US",
            "telephone_number": "901-277-3534",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MULLICK DERMATOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-09",
        "last_updated": "2022-07-27",
        "certification_date": "2022-07-27",
        "status": "A",
        "authorized_official_last_name": "MULLICK",
        "authorized_official_first_name": "SUPARNA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "901-572-0005",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "TN",
            "license": "MD49897",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sahar Mokhtari Moshref, DDS
• Robert J. Moskop, M.D.
• MSK Group, PC
• Lyle E. Muller, DDS
• Richard Grant Muller
• Suparna Mullick, MD
• Shelley N Mulrooney, PA-C
• Catherine Mulroy Munn, M.D.
• Teresa Murphree, FNP-BC
• Austin Brandon Murphy, M.D.

• Dermatology Physician in Germantown, TN
• Providers in Germantown, TN by specialty
• Dermatology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.