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Organization
NEW GENESIS CENTER FOR INTENTIONAL HEALTH & AESTHETICS
Active
Organization
NEW GENESIS CENTER FOR INTENTIONAL HEALTH & AESTHETICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICE BULLOCK FNP-C (CO-OWNER)
(229) 228-9050
Entity
Organization
Contact information
Practice address
556 HALL RD, THOMASVILLE, GA 31757-8105
(229) 228-9050
(229) 228-9056
Mailing address
556 HALL RD, THOMASVILLE, GA 31757-8105
(229) 228-9050
(229) 228-9056
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
06/23/2008
Last updated
06/23/2008
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