Healthcare Provider Details

I. General information

NPI: 1508075144
Provider Name (Legal Business Name): GREGORY GULLUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 09/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 GADSDEN HWY
BIRMINGHAM AL
35235-3134
US

IV. Provider business mailing address

1801 GADSDEN HWY
BIRMINGHAM AL
35235-3134
US

V. Phone/Fax

Practice location:
  • Phone: 205-838-3900
  • Fax: 205-838-3906
Mailing address:
  • Phone: 205-838-3900
  • Fax: 205-838-3906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number27800
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: