Individual
MS. JANET M BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
950 MATTHEW DR, WAYNESBORO, MS 39367-2567
(601) 735-5151
(601) 735-7168
Mailing address
950 MATTHEW DR, WAYNESBORO, MS 39367-2567
(601) 735-5151
(601) 735-7168
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
D1269
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D1269
STATE LICENSE
MS
Enumeration date
05/28/2011
Last updated
05/28/2011
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