Provider Demographics
NPI:1861535114
Name:MULLINS, ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:MULLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HAILE AND ROBERTS STREET
Mailing Address - Street 2:KERSHAW MEDICAL CENTER-EMERGENCY DEPT
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29020
Mailing Address - Country:US
Mailing Address - Phone:502-548-8322
Mailing Address - Fax:
Practice Address - Street 1:HAILE AND ROBERTS STREET
Practice Address - Street 2:KERSHAW MEDICAL CENTER-EMERGENCY DEPT
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29020
Practice Address - Country:US
Practice Address - Phone:502-548-8322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42736207P00000X
SC34148207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200961840Medicaid
KY42736OtherLICENSE
KY7100015100Medicaid
FM0373528OtherDEA
KY42736OtherLICENSE