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General NPI Number Information
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NPI Number | 1104138908
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Entity Type | Individual
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Provider Name | JOHN DAVID TULLOS M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/08/2010
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Last Update Date | 03/17/2022
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Provider Practice Location Address
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Address Line | 127 CRESTVIEW PARK DR STE 204
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City | DICKSON
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State | TN
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Zip | 37055-2856
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Country | US
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Telephone | 615-441-4545
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Fax | 615-441-4505
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Provider Business Mailing Address
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Address Line | 127 CRESTVIEW PARK DR STE 209
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City | DICKSON
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State | TN
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Zip | 37055-2856
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Country | US
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Telephone | 615-446-5121
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Fax | 615-446-1359
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 54403
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 54403
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License Number State | TN
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