Basic Information
| Provider Information | |||||||||
| NPI: | 1760863310 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MULLINS | ||||||||
| FirstName: | BRANDON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D., M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 MACNIDER HL | ||||||||
| Address2: | CAMPUS BOX #7005 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199664468 | ||||||||
| FaxNumber: | 9198435945 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 MACNIDER HL | ||||||||
| Address2: | CAMPUS BOX #7005 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199664468 | ||||||||
| FaxNumber: | 9198435945 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2015 | ||||||||
| LastUpdateDate: | 06/22/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 0101269166 | VA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 390200000X | 209917 | NC | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.