Provider Demographics
NPI:1902556723
Name:ULLERY, ERIC (MSW, LGSW)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:ULLERY
Suffix:
Gender:M
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 ROBERT B MILLER JR RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:GA
Mailing Address - Zip Code:31408-9001
Mailing Address - Country:US
Mailing Address - Phone:912-966-8506
Mailing Address - Fax:
Practice Address - Street 1:1401 ROBERT B MILLER JR RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:GA
Practice Address - Zip Code:31408-9001
Practice Address - Country:US
Practice Address - Phone:912-966-8506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00944094104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker