Provider Demographics
NPI:1851332787
Name:NULPH, MICHAEL R (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:NULPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:602 E 16TH AVE STE A&B
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015-1776
Mailing Address - Country:US
Mailing Address - Phone:229-513-0700
Mailing Address - Fax:229-513-0701
Practice Address - Street 1:602 E 16TH AVE STE A&B
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-1776
Practice Address - Country:US
Practice Address - Phone:229-513-0700
Practice Address - Fax:229-513-0701
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA57735207Q00000X
GA057735207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI51988Medicare UPIN