Basic Information
| Provider Information | |||||||||
| NPI: | 1770678351 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCMULLEN | ||||||||
| FirstName: | JONATHAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 344 ROLLING HILL RD | ||||||||
| Address2: | STE 102 | ||||||||
| City: | MOORESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281176865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044644439 | ||||||||
| FaxNumber: | 7046648802 | ||||||||
| Practice Location | |||||||||
| Address1: | 340 RIVERWOOD RD | ||||||||
| Address2: | |||||||||
| City: | MOORESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281178896 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049285174 | ||||||||
| FaxNumber: | 7046626946 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 01/24/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 01754 | NC | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.