Doctor Name: | MRS. PATRICE GUNTER BULLOCK |
NPI Number: | 1003974726 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSN, APRN-C |
License Number: | RN060944 |
Business Practice Address: | 115 Circle Dr Thomasville, GA - 317924706 |
Business Phone Number: | 2292259830 |
Business Fax Number: | |
Mailing Address: | 115 Circle Dr, THOMASVILLE |
State: | GA |
Postal Code: | 317924706 |
Phone Number: | 2292259830 |
Fax Number: | |
NPI Enumeration Date: | 12/05/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | RN060944 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |