Provider Demographics
NPI:1629219936
Name:PAUL, JOSE ANTONY PULIKKAL (MD)
Entity Type:Individual
Prefix:
First Name:JOSE ANTONY
Middle Name:PULIKKAL
Last Name:PAUL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:460 NORTHSIDE CHEROKEE BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-8017
Mailing Address - Country:US
Mailing Address - Phone:678-493-2527
Mailing Address - Fax:678-493-5608
Practice Address - Street 1:460 NORTHSIDE CHEROKEE BLVD STE 130
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-8017
Practice Address - Country:US
Practice Address - Phone:678-493-2527
Practice Address - Fax:678-493-5608
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA95943207RP1001X, 207RP1001X
WI64014207RC0200X, 207RP1001X
UT12717144-1205207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine