Individual
RAEONDA BULLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6095 PROFESSIONAL PKWY STE A210, DOUGLASVILLE, GA 30134-5611
(770) 949-4188
(770) 949-1614
Mailing address
6095 PROFESSIONAL PKWY STE A210, DOUGLASVILLE, GA 30134-5611
(770) 949-4188
(770) 949-1614
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
010079
GA
207V00000X
Obstetrics & Gynecology Physician
Primary
93170
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300034164A
—
GA
Enumeration date
06/08/2018
Last updated
09/26/2024
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