Provider Demographics
NPI:1902157423
Name:OLIVIA F MULLIGAN, MD, PC
Entity Type:Organization
Organization Name:OLIVIA F MULLIGAN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:F
Authorized Official - Last Name:MULLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-979-4236
Mailing Address - Street 1:2121 FOUNTAIN DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-7023
Mailing Address - Country:US
Mailing Address - Phone:770-979-4236
Mailing Address - Fax:770-979-4401
Practice Address - Street 1:2121 FOUNTAIN DR
Practice Address - Street 2:SUITE F
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-7023
Practice Address - Country:US
Practice Address - Phone:770-979-4236
Practice Address - Fax:770-979-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA19973207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty