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General NPI Number Information
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NPI Number | 1790849180
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Entity Type | Individual
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Provider Name | CHARLES R LULL MD
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Gender | Male
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 11/10/2009
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Provider Practice Location Address
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Address Line | 935 WAYNE RD
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City | SAVANNAH
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State | TN
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Zip | 38372-1937
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Country | US
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Telephone | 504-889-0347
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Fax | 504-779-9741
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Provider Business Mailing Address
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Address Line | 155 WILLOW ST
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City | SAVANNAH
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State | TN
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Zip | 38372-3690
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Country | US
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Telephone | 504-889-0347
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Fax | 504-779-9741
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD0000007740
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License Number State | TN
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