Laura Mullis, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW005190 Issued in GA

Practice address

3015 Veterans Pkwy S
Moultrie, GA 31788-6705

Phone

(229) 985-4815

NPI assigned

Dec 22, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1419206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430092800000",
    "number": "1558769786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3015 VETERANS PKWY S",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317886705",
            "telephone_number": "229-873-6479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3015 VETERANS PKWY S",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317886705",
            "telephone_number": "229-985-4815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLIS",
        "first_name": "LAURA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-22",
        "last_updated": "2015-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW005190",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Moultrie Pediatrics, LLC
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• Mukul Khurana
• Erick Myrtil, MD
• National Vision, Inc.
• Niday Drug Company LLC
• Mark Niday, PHARMD
• Cori Norman, CRNA

• All providers in Moultrie, GA
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.