Provider Demographics
NPI:1386714111
Name:PULLIAS, JENNIFER CROSS (LDN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:CROSS
Last Name:PULLIAS
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 PRESIDENT PLACE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167
Mailing Address - Country:US
Mailing Address - Phone:615-459-7104
Mailing Address - Fax:615-459-7822
Practice Address - Street 1:741 PRESIDENT PLACE
Practice Address - Street 2:SUITE 200
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167
Practice Address - Country:US
Practice Address - Phone:615-459-7104
Practice Address - Fax:615-459-7822
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN0000000943133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered