MILDRED POTTER STULL RN NP NPI 1215095468

NPI Information

NPI: 1215095468
Provider Name: MILDRED POTTER STULL, RN, NP
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
1050 MCDONOUGH RD
JACKSON, GA
ZIP 30233
Phone: (770) 775-7861
Get Directions

Mildred Potter Stull, RN, NP is a family nurse practitioner in Jackson, GA. Mildred Potter Stull, RN, NP NPI is 1215095468. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1050 MCDONOUGH RD
JACKSON, GA
ZIP 30233-524
Phone: (770) 775-7861
Fax: (770) 775-4478

The NPI 1215095468 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Power Mobility Devices.

The enumeration date for this NPI number is 12/4/2006 and was last updated on 7/9/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	RN043103	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	50BBKBS	MEDICARE ID-TYPE UNSPECIFIED	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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