Basic Information
| Provider Information | |||||||||
| NPI: | 1245202035 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MULLIS | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | ASHLEY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 658 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305030658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7077181122 | ||||||||
| FaxNumber: | 7705354786 | ||||||||
| Practice Location | |||||||||
| Address1: | 725 JESSE JEWELL PKWY SE | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305013834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707181122 | ||||||||
| FaxNumber: | 7705357445 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2006 | ||||||||
| LastUpdateDate: | 08/05/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 26933 | SC | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 060414 | GA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 01162479 | 01 | GA | AMERIGROUP | OTHER | 429270 | 01 | GA | WELLCARE | OTHER | 530057171A | 05 | GA | MEDICAID | 52162699 | 01 | GA | BCBS | OTHER | 530057171B | 05 | GA | MEDICAID | 9223107 | 01 | GA | AETNA | OTHER | P00633303 | 01 | GA | MEDICARE RAILROAD | OTHER | 2448767 | 01 | GA | UNITED HEALTHCARE | OTHER | 4066030 | 01 | GA | CIGNA | OTHER | P00219012 | 01 | SC | RAILROAD MEDICARE | OTHER | 530057171D | 05 | GA | MEDICAID | 269337 | 05 | SC | MEDICAID | 530057171C | 05 | GA | MEDICAID |