Provider Demographics
NPI:1174961304
Name:HULSEY, MEREDITH MICHELLE TATUM (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:MICHELLE TATUM
Last Name:HULSEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MEREDITH
Other - Middle Name:MICHELLE
Other - Last Name:TATUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1080 LUMPKIN CAMPGROUND ROAD S
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534
Mailing Address - Country:US
Mailing Address - Phone:706-265-4100
Mailing Address - Fax:706-265-4132
Practice Address - Street 1:1080 LUMPKIN CAMPGROUND ROAD S
Practice Address - Street 2:SUITE 300
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534
Practice Address - Country:US
Practice Address - Phone:706-265-4100
Practice Address - Fax:706-265-4132
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6834363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003168393AMedicaid