Healthcare Provider Details

I. General information

NPI: 1902723000
Provider Name (Legal Business Name): FREDRICA GOODSON BULL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3018 WILD TURKEY DR
EFFINGHAM SC
29541-4718
US

IV. Provider business mailing address

3018 WILD TURKEY DR
EFFINGHAM SC
29541-4718
US

V. Phone/Fax

Practice location:
  • Phone: 843-616-4601
  • Fax:
Mailing address:
  • Phone: 843-616-4601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number32262
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: