Individual
MARQUETTA BULLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
659 WREN WALK, STONE MOUNTAIN, GA 30087-7204
(404) 429-1470
Mailing address
659 WREN WALK, STONE MOUNTAIN, GA 30087-7204
(404) 429-1470
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
CO138476
GA
Other
Enumeration date
03/07/2022
Last updated
03/09/2022
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