MEDICARE: ERIC ULLERY MSW, LGSW

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	104100000X	Social Worker	BP00944094	WV

General Provider Information

NPI Number	:	1902556723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC ULLERY MSW, LGSW

Provider Business Mailing Address
First Line	:	1401 ROBERT B MILLER JR RD
Second Line	:
City	:	GARDEN CITY
State	:	GA
Zip	:	31408-9001
Country	:	US
Telephone Number	:	912-966-8506
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 ROBERT B MILLER JR RD
Second Line	:
City	:	GARDEN CITY
State	:	GA
Zip	:	31408-9001
Country	:	US
Telephone Number	:	912-966-8506
Fax Number	:

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

Provider Enumeration Date	:	03/25/2022
Last Update Date	:	03/25/2022

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