Provider Demographics
NPI:1871541177
Name:MULLINAX, CLARICE WEATHERS (MD)
Entity type:Individual
Prefix:DR
First Name:CLARICE
Middle Name:WEATHERS
Last Name:MULLINAX
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2595 CENTRAL AVE
Mailing Address - Street 2:CHRIST COMMUNITY HEALTH SERVICES INC
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-5905
Mailing Address - Country:US
Mailing Address - Phone:901-260-8500
Mailing Address - Fax:901-260-8590
Practice Address - Street 1:3124 NORTH THOMAS STREET
Practice Address - Street 2:CHRIST COMMUNITY HEALTH SERVICES INC
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127
Practice Address - Country:US
Practice Address - Phone:901-260-8400
Practice Address - Fax:901-260-8590
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2011-12-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD0000036835207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3879609Medicaid
TNH65497Medicare UPIN
TN3879609Medicaid