Provider Demographics
NPI:1427237775
Name:ELITE MEDICAL ASSOCIATES, PC
Entity type:Organization
Organization Name:ELITE MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:B
Authorized Official - Last Name:PULLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-375-4400
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31539-0729
Mailing Address - Country:US
Mailing Address - Phone:912-375-4400
Mailing Address - Fax:912-375-4499
Practice Address - Street 1:143 S TALLAHASSEE ST
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:GA
Practice Address - Zip Code:31539-6466
Practice Address - Country:US
Practice Address - Phone:912-375-4400
Practice Address - Fax:911-237-5449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051068174400000X
GA049936174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA362318407AMedicaid
GA455996743AMedicaid
GAGRP6201Medicare PIN