Individual
DR. HONORIO R BULOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.,F.A.A.P.
Contact information
Practice address
300 DAWSON COMMONS CIR, STE 320, DAWSONVILLE, GA 30534-6268
(706) 216-2770
(706) 216-2944
Mailing address
300 DAWSON COMMONS CIR, STE 320, DAWSONVILLE, GA 30534-6268
(706) 216-2770
(706) 216-2944
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
48029
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000862584B
PEACHSTATE
GA
05
—
000862584B
—
GA
05
—
000862584C
—
GA
01
—
10032539
AMERIGROUP
GA
01
—
10049707
AMERIGROUP TLC
GA
01
—
328286
WELLCARE
GA
01
—
341290
WELLCARE TLC
GA
01
—
52837775
BCBS OF GA
GA
Enumeration date
04/27/2006
Last updated
05/08/2013
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