Provider Demographics
NPI:1154628451
Name:WELLPULL CORPORATION OF EVANS
Entity type:Organization
Organization Name:WELLPULL CORPORATION OF EVANS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:PULLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-513-2424
Mailing Address - Street 1:465 N BELAIR RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3188
Mailing Address - Country:US
Mailing Address - Phone:706-513-2424
Mailing Address - Fax:706-854-2425
Practice Address - Street 1:465 N BELAIR RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3188
Practice Address - Country:US
Practice Address - Phone:706-513-2424
Practice Address - Fax:706-854-2425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies