Healthcare Provider Details

I. General information

NPI: 1497754840
Provider Name (Legal Business Name): SHARON LYNN BULLARD MSSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 HARMON AVE WACH-BEHAVIORAL HEALTH CLINIC
FT STEWART GA
31314-5844
US

IV. Provider business mailing address

1061 HARMON AVE STE 1D03 WACH-WINN ARMY COMMUNITY HOSPI
FORT STEWART GA
31314-5641
US

V. Phone/Fax

Practice location:
  • Phone: 912-767-1647
  • Fax: 912-767-3507
Mailing address:
  • Phone: 912-767-1647
  • Fax: 912-767-3507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5089
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: