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SHAN DAVID TULLY FNP-C
NPI 1275498131
Nurse Practitioner in Hiram, GA

Active since December 22, 2025PECOS Enrolled
6736 BILL CARRUTH PKWY APT 805, HIRAM, GA 30141(470) 330-0826 Get Directions Write a Review

NPPES record last updated: December 22, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Shan David Tully Fnp-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHAN DAVID TULLY FNP-C (NPI 1275498131) is an individual nurse practitioner in Hiram, Georgia, licensed in Georgia (APRN-NP294893) and active in the NPI registry since December 2025. He is enrolled in Medicare PECOS and is a graduate of Other (2025).

NPPES Registry Identity

NPI1275498131
Entity TypeIndividualMale
Primary Taxonomy363L00000X
Provider Legal NameSHAN DAVID TULLYCredential: FNP-C
Location Address6736 BILL CARRUTH PKWY APT 805Hiram, GA 30141-3794
Mailing Address6736 Bill Carruth Pkwy Apt 805Hiram, GA 30141-3794 · (470) 330-0826
Phone(470) 330-0826
Sole ProprietorNo
Medical School CMSOtherGraduated 2025
Enumeration DateDecember 22, 2025
NPPES CertifiedDecember 22, 2025
✔ NPI 1275498131 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License✔ Licensed in GA · APRN-NP294893
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
6736 BILL CARRUTH PKWY APT 805, Hiram, GA 30141
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Shan David Tully Fnp-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID1052877701
PECOS Enrollment IDI20260802000164
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Shan Tully reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Peachtree Immediate Care Fp, LLC
2.2 mi
Family Medicine
3827 JIMMY LEE SMITH PKWY
Hiram, GA 30141
  • Reassigned Medicare billing, Georgia enrollment
  • 551 clinicians in this Medicare group
NPI 1437194156 (770) 222-8900

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 30141 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$88.06 typical visit price
range $56.84 – $172.43
Typical copayment $22.01 (range $14.21 – $43.10)
Most-billed visit code 99203
Established Patient
$100.20 typical visit price
range $18.22 – $140.40
Typical copayment $25.05 (range $4.55 – $35.10)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shan Tully's NPI number?

The NPI number for Shan Tully is 1275498131. It was assigned to this individual provider in the NPPES registry on December 22, 2025.

Where is Shan Tully located?

Shan Tully practices at 6736 Bill Carruth Pkwy Apt 805, Hiram, GA 30141. The listed phone number is (470) 330-0826.

What is Shan Tully's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Shan Tully enrolled in Medicare?

Yes. Shan Tully is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Shan Tully's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Shan Tully reassigns Medicare benefits to Peachtree Immediate Care Fp, LLC (Hiram, GA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Shan Tully's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Shan Tully was last updated on December 22, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.