Provider Demographics
NPI:1952871055
Name:PULLIAM, GLENDA (A-GNP)
Entity Type:Individual
Prefix:MISS
First Name:GLENDA
Middle Name:
Last Name:PULLIAM
Suffix:
Gender:F
Credentials:A-GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 746725
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6725
Mailing Address - Country:US
Mailing Address - Phone:601-533-7017
Mailing Address - Fax:601-533-7016
Practice Address - Street 1:5339 ELVIS PRESLEY BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-8243
Practice Address - Country:US
Practice Address - Phone:901-504-7002
Practice Address - Fax:901-389-5661
Is Sole Proprietor?:No
Enumeration Date:2018-11-30
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22404363LA2200X
NC5012679363LA2200X, 363LG0600X
TN32063363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology