MULLICK DERMATOLOGY, PLLC
NPI 1154862217
Dermatology in Germantown, TN

Active since March 09, 2017
3036 CENTRE OAK WAY, GERMANTOWN, TN 38138(901) 572-0005 Get Directions Write a Review

NPPES record last updated: July 27, 2022. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jul 27, 2022, Mar 13, 2017 (2 updates tracked since 2017).

About Mullick Dermatology, Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MULLICK DERMATOLOGY, PLLC (NPI 1154862217) is a healthcare organization registered as a dermatology in Germantown, Tennessee and active in the NPI registry since March 2017. The organization maintains a secondary practice location in Germantown and lists Suparna Mullick, President, as its authorized official.

NPPES Registry Identity

NPI1154862217
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameMULLICK DERMATOLOGY, PLLC
Location Address3036 CENTRE OAK WAYGermantown, TN 38138-6302
Mailing AddressPo Box 758Paris, TN 38242-0758 · (901) 572-0005
Organization SubpartNo
Authorized OfficialSuparna MullickPresident · (901) 572-0005
Enumeration DateMarch 9, 2017
Last NPPES UpdateJuly 27, 20222 updates tracked since enumeration
NPPES CertifiedJuly 27, 2022
✔ NPI 1154862217 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
License✔ Licensed in TN · MD49897
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
3036 CENTRE OAK WAY, Germantown, TN 38138

Secondary Practice Location 1

Location 19760 Lipsey CvGermantown, TN 38139-8076 · Phone (901) 277-3534

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mullick Dermatology, Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Mullick Dermatology, PLLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Dermatology
NPI 1366547713
3036 CENTRE OAK WAY
Germantown, TN 38138
(901) 572-0005
✔ PECOSSame address
Nurse Practitioner
NPI 1699059667
3036 CENTRE OAK WAY
Germantown, TN 38138
(901) 572-0005
✔ PECOSSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mullick Dermatology, PLLC's NPI number?

The NPI number for Mullick Dermatology, PLLC is 1154862217. It was assigned to this organization in the NPPES registry on March 9, 2017.

Where is Mullick Dermatology, PLLC located?

Mullick Dermatology, PLLC is located at 3036 Centre Oak Way, Germantown, TN 38138. The listed phone number is (901) 572-0005.

What is Mullick Dermatology, PLLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Is Mullick Dermatology, PLLC enrolled in Medicare?

Yes. Mullick Dermatology, PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Mullick Dermatology, PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Mullick Dermatology, PLLC, in Dermatology and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Mullick Dermatology, PLLC was last updated on July 27, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.