MEDICARE: ANNE CONSTANIA BULLOCK M.D.

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	207UN0901X	Nuclear Cardiology Physician	032140	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	360003154/CM0845	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477547784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE CONSTANIA BULLOCK M.D.

Provider Business Mailing Address
First Line	:	805 SANDY PLAINS ROAD
Second Line	:	MEDICAL STAFF SERVICES
City	:	MARIETTA
State	:	GA
Zip	:	30066-6340
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	619 S 8TH ST STE 301
Second Line	:
City	:	GRIFFIN
State	:	GA
Zip	:	30224-4260
Country	:	US
Telephone Number	:	770-229-6072
Fax Number	:

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

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	10/31/2022

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