Healthcare Provider Details

I. General information

NPI: 1952697336
Provider Name (Legal Business Name): MICHAEL GARY HULL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 04/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TOWER RD NE STE 200
MARIETTA GA
30060
US

IV. Provider business mailing address

300 TOWER RD NE STE 200
MARIETTA GA
30060-9403
US

V. Phone/Fax

Practice location:
  • Phone: 770-427-5717
  • Fax:
Mailing address:
  • Phone: 770-427-5717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number78499
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: