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General NPI Number Information
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NPI Number | 1518095124
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Entity Type | Individual
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Provider Name | TRACY PULLIAM M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 11/23/2010
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Provider Practice Location Address
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Address Line | 1 HOSPITAL DRIVE SE CRESTWOOD HOSPITAL
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City | HUNTSVILLE
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State | AL
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Zip | 35801
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Country | US
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Telephone | 256-429-5196
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Fax | 256-429-4573
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Provider Business Mailing Address
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Address Line | PO BOX 1814
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City | MADISON
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State | AL
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Zip | 35758-5410
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Country | US
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Telephone | 256-429-5196
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Fax | 256-429-4573
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 26489
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 26489
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License Number State | AL
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