Individual
BETH ANN BULAWA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1404 TUSCULUM BLVD STE 2100, GREENEVILLE, TN 37745-4329
(423) 783-5580
Mailing address
1021 W OAKLAND AVE STE 310, JOHNSON CITY, TN 37604-2192
(423) 302-6565
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
191942
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01452991
—
NY
01
—
1532375
BLUECARE
TN
05
—
1532375
—
TN
01
—
4356397
BCBST
TN
01
—
P01225987
RAILROAD MEDICARE
TN
Enumeration date
09/21/2005
Last updated
11/14/2023
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