Individual
MRS. JACQUELINE YVONNE BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
155 TREADWICK DR # 5653, ATLANTA, GA 30350-5653
(470) 514-5954
Mailing address
155 TREADWICK DR # 5653, ATLANTA, GA 30350-5653
(470) 514-5954
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
CN001423501
TN
Other
Enumeration date
06/09/2022
Last updated
06/09/2022
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