Active NPI
Thomas N Mullen, M.D.
- Family Medicine Physician
- Ringgold, GA
National Provider Identifier
1174520837
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 39882
- Practice address
- 126 Sequoyah TRL
Ringgold, GA 30736-4360 - Phone
- (706) 965-2179
- NPI assigned
- Jul 7, 2005
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 39882 | GA | Primary |
Addresses
Primary practice location
126 Sequoyah TRL
Ringgold, GA 30736-4360
Mailing address
738 Deodara Dr
Altadena, CA 91001-2310
Phone (626) 676-3797
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000645169C | Medicaid | GA |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39882 | GA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hamilton Physician Group Inc | Past | Accepting new patients | |
| Khan Internal Medicine Center | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Cardiovascular Disease Physician
- Dalton, GA
- NPI 1235455569
-
- Internal Medicine Physician
- Dalton, GA
- NPI 1922416171
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1281312000000",
"number": "1174520837",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "738 DEODARA DR",
"city": "ALTADENA",
"state": "CA",
"postal_code": "910012310",
"telephone_number": "626-676-3797"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "126 SEQUOYAH TRL",
"city": "RINGGOLD",
"state": "GA",
"postal_code": "307364360",
"telephone_number": "706-965-2179"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULLEN",
"first_name": "THOMAS",
"middle_name": "N",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-07-07",
"last_updated": "2010-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "GA",
"license": "39882",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000645169C",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ringgold, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.