Provider Demographics
NPI:1437149978
Name:PULLIAM, MORRIS MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MORRIS
Middle Name:MICHAEL
Last Name:PULLIAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 469
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30015-0469
Mailing Address - Country:US
Mailing Address - Phone:770-786-9312
Mailing Address - Fax:770-784-9603
Practice Address - Street 1:4165 HOSPITAL DR NE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2565
Practice Address - Country:US
Practice Address - Phone:770-786-9312
Practice Address - Fax:770-784-9603
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2015-05-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA11036207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5809692830000EOtherALL OTHER CARRIERS
GA451376OtherSTATE MERIT SYSTEM
GA067332OtherBLUE CROSS BLUE SHIELD
GA000012229DMedicaid
GA406180004OtherRRR MEDICARE
GA000012229DMedicaid
GA451376OtherSTATE MERIT SYSTEM
GA422544OtherBCBS MADISON
GA669902OtherSMS MADISON
GA000012229DMedicaid