Individual
DR. COLETTE DEVONA BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
5422 CUMMING HWY STE 104, SUGAR HILL, GA 30518-7027
(678) 466-9193
(877) 991-5350
Mailing address
5422 CUMMING HWY STE 104, SUGAR HILL, GA 30518-7027
(678) 765-7147
(877) 991-5350
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
25MB08802400
NJ
207R00000X
Internal Medicine Physician
Primary
75415
GA
207R00000X
Internal Medicine Physician
OS015213
PA
Other
Enumeration date
07/25/2007
Last updated
10/08/2022
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