Healthcare Provider Details

I. General information

NPI: 1225872724
Provider Name (Legal Business Name): AMANDA DEANN PULLMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CLIFTON RD NE FL 3
ATLANTA GA
30329-4018
US

IV. Provider business mailing address

3373 LATHENVIEW CT
ALPHARETTA GA
30004-8912
US

V. Phone/Fax

Practice location:
  • Phone: 404-718-5770
  • Fax:
Mailing address:
  • Phone: 810-516-6828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License NumberTN45906
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: