Individual
SAMUEL MARK BULLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3783 GALDWAY DR, SNELLVILLE, GA 30039-5123
(678) 404-1396
Mailing address
3783 GALDWAY DR, SNELLVILLE, GA 30039-5123
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD006062
GA
Other
Enumeration date
04/23/2025
Last updated
04/23/2025
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