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NPI Code Detail

MEDICARE: MARY FULP-PYE LCSW

MEDICARE: MARY FULP-PYE LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker001211GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003816935
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY FULP-PYE LCSW
Provider Business Mailing Address
First Line : PO BOX 3229
Second Line :
City : VALDOSTA
State : GA
Zip : 31604-3229
Country : US
Telephone Number : 229-244-4200
Fax Number : 229-244-4995
Provider Business Practice Location Address
First Line : 3541 N CROSSING CIR
Second Line :
City : VALDOSTA
State : GA
Zip : 31602-1019
Country : US
Telephone Number : 229-244-4200
Fax Number : 229-244-4995
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2005
Last Update Date : 03/25/2010

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Directions to “ MARY FULP-PYE LCSW” Practice Location

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