Individual
DR. ERICK C BULAWA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
438 E VANN RD STE 201, GREENEVILLE, TN 37743-7202
(423) 278-1800
(423) 278-1805
Mailing address
1021 W OAKLAND AVE STE 310, JOHNSON CITY, TN 37604-2192
(423) 302-6565
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
179208
TN
207RB0002X
Obesity Medicine (Internal Medicine) Physician
179208
TN
208000000X
Pediatrics Physician
179208
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01458891
—
NY
01
—
4357373
BCBST
TN
01
—
P01237829
RAILROAD MEDICARE
TN
05
—
Q001917
—
TN
Enumeration date
11/17/2005
Last updated
11/14/2023
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