Provider Demographics
NPI:1295154482
Name:PULASKI PEDIATRICS, PLLC
Entity type:Organization
Organization Name:PULASKI PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:ANGELES
Authorized Official - Last Name:FRANCO-CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-424-5437
Mailing Address - Street 1:1125 E COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-4520
Mailing Address - Country:US
Mailing Address - Phone:931-424-5437
Mailing Address - Fax:931-424-5448
Practice Address - Street 1:1125 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-4520
Practice Address - Country:US
Practice Address - Phone:931-424-5437
Practice Address - Fax:931-424-5448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000011697363LF0000X
TN37925208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3206601Medicaid