Provider Demographics
NPI:1104036722
Name:PULLIAM MIDDLE TENNESSEE SURGICAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:PULLIAM MIDDLE TENNESSEE SURGICAL ASSOCIATES PLLC
Other - Org Name:MIDDLE TENNESSEE VASCULAR ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-369-6336
Mailing Address - Street 1:808 HATCHER LANE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401
Mailing Address - Country:US
Mailing Address - Phone:931-388-6256
Mailing Address - Fax:615-791-4531
Practice Address - Street 1:4601 CAROTHERS PARKWAY
Practice Address - Street 2:SUITE 375
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067
Practice Address - Country:US
Practice Address - Phone:615-791-4790
Practice Address - Fax:615-791-4531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMD154442086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3728798Medicare PIN