Individual
SHAN DAVID TULLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
6736 BILL CARRUTH PKWY APT 805, HIRAM, GA 30141-3794
(470) 330-0826
Mailing address
6736 BILL CARRUTH PKWY APT 805, HIRAM, GA 30141-3794
(470) 330-0826
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APRN-NP294893
GA
Other
Enumeration date
12/22/2025
Last updated
12/22/2025
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