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NPI Code Detail

MEDICARE: DR. HANNAH GULLICKSON FOLSOM DO

MEDICARE: DR. HANNAH GULLICKSON FOLSOM DO
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
1207Q00000XFamily Medicine Physician11964GA

General Provider Information

NPI Number : 1548885940
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HANNAH GULLICKSON FOLSOM DO
Provider Business Mailing Address
First Line : PO BOX 2510
Second Line :
City : EVANS
State : GA
Zip : 30809-2510
Country : US
Telephone Number : 706-842-3959
Fax Number : 706-922-6695
Provider Business Practice Location Address
First Line : 4039 GATEWAY BLVD
Second Line :
City : GROVETOWN
State : GA
Zip : 30813-3389
Country : US
Telephone Number : 706-922-1600
Fax Number : 706-922-1010
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2020
Last Update Date : 03/21/2024

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