Individual
MR. GEORGE EDWARD BULLOCK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, ATC
Contact information
Practice address
2000 CENTURYTEL CENTER DR, BOSSIER CITY, LA 71112-4586
(318) 752-2847
(318) 741-9032
Mailing address
8938 BRANDON DR, SHREVEPORT, LA 71118-2327
(318) 464-5254
(318) 741-9032
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
ATH.J00311
LA
Other
Enumeration date
07/15/2006
Last updated
03/05/2009
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