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Individual

ANISA BULLOCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSN, AGACNP-BC

Contact information

Practice address
242 KING AVENUE SUITE 210, ATHENS, GA 30606
(706) 475-1700
Mailing address
554 STERLING WATER DR, MONROE, GA 30655-7704
(404) 519-6862

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN220223
GA
363LA2100X
Acute Care Nurse Practitioner
RN220223
GA

Other

Enumeration date
12/03/2018
Last updated
03/09/2022
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