Provider Demographics
NPI:1013329846
Name:MULLIS, TABITHA HENDRIX (NP-C)
Entity type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:HENDRIX
Last Name:MULLIS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MRS
Other - First Name:TABITHA
Other - Middle Name:HENDRIX
Other - Last Name:SAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:206 HOSPITAL DR STE A
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2560
Mailing Address - Country:US
Mailing Address - Phone:478-272-3525
Mailing Address - Fax:478-272-3589
Practice Address - Street 1:206 HOSPITAL DR STE A
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2560
Practice Address - Country:US
Practice Address - Phone:478-272-3525
Practice Address - Fax:478-272-3589
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN167847363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily