Healthcare Provider Details

I. General information

NPI: 1033105440
Provider Name (Legal Business Name): MICHAEL ANDREW HULSE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 TOWNE LAKE PKWY STE 404
WOODSTOCK GA
30189-1604
US

IV. Provider business mailing address

433 HIGHLAND PKWY STE 203
EAST ELLIJAY GA
30540-6989
US

V. Phone/Fax

Practice location:
  • Phone: 770-926-9229
  • Fax: 678-415-2164
Mailing address:
  • Phone: 706-698-6400
  • Fax: 706-698-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number040695
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: