Healthcare Provider Details

I. General information

NPI: 1790728145
Provider Name (Legal Business Name): REMUS B BULLARD III PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 05/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 9TH AVENUE DR NE
HICKORY NC
28601-3829
US

IV. Provider business mailing address

311 9TH AVENUE DR NE
HICKORY NC
28601-3829
US

V. Phone/Fax

Practice location:
  • Phone: 828-322-7338
  • Fax: 828-304-6319
Mailing address:
  • Phone: 828-322-7338
  • Fax: 828-304-6319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number102375
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: