Provider Demographics
NPI:1043208721
Name:PULLIAM, JAMES M (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:PULLIAM
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:PO BOX 2837
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:KY
Mailing Address - Zip Code:42135-2837
Mailing Address - Country:US
Mailing Address - Phone:270-586-3258
Mailing Address - Fax:270-586-9687
Practice Address - Street 1:131 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:KY
Practice Address - Zip Code:42134-2752
Practice Address - Country:US
Practice Address - Phone:270-586-3258
Practice Address - Fax:270-586-9687
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY15919207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4370146OtherAETNA
47403OtherANTHEM
0771888001OtherCIGNA
KY64159197Medicaid
1208701Medicare ID - Type Unspecified
0771888001OtherCIGNA