| Doctor Name: | MR. RONALD GERALD MULLIS |
| NPI Number: | 1023114774 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | PA4476 |
| Business Practice Address: | 316 N Broad St Winder, GA - 306802150 |
| Business Phone Number: | 7708673400 |
| Business Fax Number: | |
| Mailing Address: | 14050 Nw 14th St, Suite 190 SUNRISE |
| State: | FL |
| Postal Code: | 333232865 |
| Phone Number: | 8004243672 |
| Fax Number: | 9543773042 |
| NPI Enumeration Date: | 09/16/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA4476 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |