Provider Demographics
NPI:1376995753
Name:PICKARD, ULYSSES CLIFFORD (DMD)
Entity Type:Individual
Prefix:DR
First Name:ULYSSES
Middle Name:CLIFFORD
Last Name:PICKARD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:THOMSON
Mailing Address - State:GA
Mailing Address - Zip Code:30824-2416
Mailing Address - Country:US
Mailing Address - Phone:706-595-2651
Mailing Address - Fax:
Practice Address - Street 1:540 JACKSON ST
Practice Address - Street 2:
Practice Address - City:THOMSON
Practice Address - State:GA
Practice Address - Zip Code:30824-2416
Practice Address - Country:US
Practice Address - Phone:706-595-2651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015223122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist