Provider Demographics
NPI:1205091279
Name:LULA GILLIAM & ASSOCIATES, INC
Entity type:Organization
Organization Name:LULA GILLIAM & ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LULA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-256-0275
Mailing Address - Street 1:1514 EAST CLEVELAND AVE
Mailing Address - Street 2:SUITE 99-A
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-6965
Mailing Address - Country:US
Mailing Address - Phone:770-256-0275
Mailing Address - Fax:404-761-4253
Practice Address - Street 1:1514 EAST CLEVELAND AVE
Practice Address - Street 2:SUITE 99-A
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-6965
Practice Address - Country:US
Practice Address - Phone:770-256-0275
Practice Address - Fax:404-761-4253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-18
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health