Organization
LOCUST GROVE CLINIC, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER J TULLY D.C. (PRES)
(770) 898-0028
Entity
Organization
Contact information
Practice address
2648 HIGHWAY 42, LOCUST GROVE, GA 30248-2519
(770) 898-0028
(770) 898-7987
Mailing address
2648 HIGHWAY 42, LOCUST GROVE, GA 30248-2519
(770) 898-0028
(770) 898-7987
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIROO6323
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GRP4337
MEDICARE GROUP
GA
Enumeration date
10/19/2007
Last updated
10/19/2007
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