MEDICARE: GUINEVERE JOHNSON BULLARD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	2023-03325	NC

General Provider Information

NPI Number	:	1417926965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUINEVERE JOHNSON BULLARD MD

Provider Business Mailing Address
First Line	:	PO BOX 19305
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28219-9305
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16455 STATESVILLE RD
Second Line	:	STE 400
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-7135
Country	:	US
Telephone Number	:	704-801-2130
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	07/15/2024

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