Provider Demographics
NPI:1144878448
Name:MULLINS, JEFFREY BRYAN (ATC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:BRYAN
Last Name:MULLINS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 20TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-1522
Mailing Address - Country:US
Mailing Address - Phone:423-364-0169
Mailing Address - Fax:
Practice Address - Street 1:1120 N OCOEE ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-4475
Practice Address - Country:US
Practice Address - Phone:423-614-8462
Practice Address - Fax:423-614-8438
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000005932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer