Healthcare Provider Details

I. General information

NPI: 1548599608
Provider Name (Legal Business Name): CHADRICK LEON HULL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2009
Last Update Date: 09/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 S WEBB AVE
CROSSVILLE TN
38555-8495
US

IV. Provider business mailing address

131 S WEBB AVE
CROSSVILLE TN
38555-8495
US

V. Phone/Fax

Practice location:
  • Phone: 931-484-5379
  • Fax: 931-484-5946
Mailing address:
  • Phone: 931-484-5379
  • Fax: 931-484-5946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1825
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: