Healthcare Provider Details

I. General information

NPI: 1659372449
Provider Name (Legal Business Name): CHARLES DAVID TULLIUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S CENTER AVE
SOMERSET PA
15501-2033
US

IV. Provider business mailing address

779 SOUTHBRIDGE BLVD
SAVANNAH GA
31405-8132
US

V. Phone/Fax

Practice location:
  • Phone: 800-394-4445
  • Fax: 706-955-0735
Mailing address:
  • Phone: 412-260-9767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35539
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD-045423-L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number41014
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: