Individual
MR. KEITH ELDON BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S., CCC/ SLP
Contact information
Practice address
1835 SAVOY DR, SUITE 100, ATLANTA, GA 30341-1072
(678) 298-9484
(678) 826-4033
Mailing address
1835 SAVOY DR, SUITE 100, ATLANTA, GA 30341-1072
(678) 298-9484
(678) 826-4033
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP007934
GA
Other
Enumeration date
10/01/2012
Last updated
11/13/2012
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