Provider Demographics
NPI:1568568491
Name:TULLY, ELIZABETH CATHERINE (DC)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:CATHERINE
Last Name:TULLY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:CATHERINE
Other - Last Name:PLANTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:835 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-4137
Mailing Address - Country:US
Mailing Address - Phone:770-898-0028
Mailing Address - Fax:770-898-7987
Practice Address - Street 1:835 JACKSON ST
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-4137
Practice Address - Country:US
Practice Address - Phone:770-898-0028
Practice Address - Fax:770-898-7987
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA6332111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADOL205152800OtherDEPARTMENT OF LABOR
GA801714OtherBLUE CROSS BLUE SHIELD
GA801714OtherBLUE CROSS BLUE SHIELD
GAU89106Medicare UPIN
GADOL205152800OtherDEPARTMENT OF LABOR