Basic Information
| Provider Information | |||||||||
| NPI: | 1457328049 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HULM | ||||||||
| FirstName: | DENNIS | ||||||||
| MiddleName: | ALFRED | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11955 | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383080132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8886300845 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 620 SKYLINE DRIVE | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383013901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7315416174 | ||||||||
| FaxNumber: | 7315418008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2006 | ||||||||
| LastUpdateDate: | 04/27/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD37894 | TN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 3888479 | 05 | TN | MEDICAID | 3888478 | 05 | TN | MEDICAID | 4102674 | 01 | BCBS | OTHER | P00109839 | 01 | RR MEDICARE | OTHER | P00264044 | 01 | RR MEDICARE | OTHER | DC538Z | 01 | HI | PALMETTO HAWAII | OTHER | 3888472 | 05 | TN | MEDICAID | 4068852 | 01 | BCBS | OTHER |