Provider Demographics
NPI:1285011809
Name:PELICAN, INC
Entity Type:Organization
Organization Name:PELICAN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:YUL
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:GASH
Authorized Official - Suffix:
Authorized Official - Credentials:RNFA
Authorized Official - Phone:404-226-7769
Mailing Address - Street 1:3961 FLOYD ROAD
Mailing Address - Street 2:SUITE 300-350
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-8536
Mailing Address - Country:US
Mailing Address - Phone:404-226-7769
Mailing Address - Fax:
Practice Address - Street 1:3961 FLOYD ROAD
Practice Address - Street 2:SUITE 300-350
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-8536
Practice Address - Country:US
Practice Address - Phone:404-226-7769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty