Individual
JOHNNY BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
62 HIGHWAY 587, FOXWORTH, MS 39483-5026
(601) 424-3540
(601) 424-3544
Mailing address
PO BOX 669, FOXWORTH, MS 39483-0669
(601) 424-3540
(601) 424-3544
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
13883
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00737837
—
MS
Enumeration date
05/05/2006
Last updated
11/01/2012
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