Individual
ANNE CONSTANIA BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
619 S 8TH ST STE 301, GRIFFIN, GA 30224-4260
(770) 229-6072
Mailing address
805 SANDY PLAINS ROAD, MEDICAL STAFF SERVICES, MARIETTA, GA 30066-6340
Taxonomy
Speciality
Code
Description
License number
State
207UN0901X
Nuclear Cardiology Physician
Primary
032140
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00569698B
—
GA
01
—
360003154/CM0845
RAILROAD MEDICARE
GA
Enumeration date
09/01/2005
Last updated
10/31/2022
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