MEDICARE: LULA GILLIAM & ASSOCIATES, INC

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
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1205091279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LULA GILLIAM & ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	1514 EAST CLEVELAND AVE
Second Line	:	SUITE 99-A
City	:	EAST POINT
State	:	GA
Zip	:	30344-6965
Country	:	US
Telephone Number	:	770-256-0275
Fax Number	:	404-761-4253

Provider Business Practice Location Address
First Line	:	1514 EAST CLEVELAND AVE
Second Line	:	SUITE 99-A
City	:	EAST POINT
State	:	GA
Zip	:	30344-6965
Country	:	US
Telephone Number	:	770-256-0275
Fax Number	:	404-761-4253

Authorized Official
Title or Position	:	CEO
Name	:	MS. LULA GILLIAM
Credential	:
Telephone Number	:	770-256-0275

Provider Enumeration Date	:	07/18/2008
Last Update Date	:	08/22/2008

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