MEDICARE: EYDIE PULLMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C6036	MS

General Provider Information

NPI Number	:	1518207513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EYDIE PULLMAN

Provider Business Mailing Address
First Line	:	111A MAIN ST W
Second Line	:
City	:	NEW ALBANY
State	:	MS
Zip	:	38652-3324
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	111A MAIN ST W
Second Line	:
City	:	NEW ALBANY
State	:	MS
Zip	:	38652-3324
Country	:	US
Telephone Number	:	662-202-8846
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2013
Last Update Date	:	02/27/2013

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