Provider Demographics
NPI:1093704397
Name:PULLIN, PATRICK BERNARD (MD)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:BERNARD
Last Name:PULLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:550 PEACHTREE ST NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2208
Mailing Address - Country:US
Mailing Address - Phone:912-375-4400
Mailing Address - Fax:912-375-4499
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2208
Practice Address - Country:US
Practice Address - Phone:912-375-4400
Practice Address - Fax:912-375-4499
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049936207R00000X
GA49936208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA455996743AMedicaid
GA11BDXGNMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE
GA455996743AMedicaid