Provider Demographics
NPI:1033105440
Name:HULSE, MICHAEL ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANDREW
Last Name:HULSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 HIGHLAND PKWY
Mailing Address - Street 2:STE 203
Mailing Address - City:EAST ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-6989
Mailing Address - Country:US
Mailing Address - Phone:706-698-6400
Mailing Address - Fax:706-698-6401
Practice Address - Street 1:900 TOWNE LAKE PKWY STE 404
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-1604
Practice Address - Country:US
Practice Address - Phone:770-926-9229
Practice Address - Fax:678-415-2164
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040695207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000852354EMedicaid
G81631Medicare UPIN
G81631Medicare UPIN