Individual
GABRIEL MAHASI BULUKU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
969 LAKELAND DR, JACKSON, MS 39216-4606
(601) 200-4644
(601) 200-4645
Mailing address
PO BOX 22727, JACKSON, MS 39225-2727
(601) 200-4644
(601) 200-4645
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
27932
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/29/2016
Last updated
08/13/2020
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