Healthcare Provider Details

I. General information

NPI: 1033668264
Provider Name (Legal Business Name): ALISON PAIGE BULL P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2016
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 OLD TROLLEY RD STE 300
SUMMERVILLE SC
29485-5294
US

IV. Provider business mailing address

PO BOX 530062
ATLANTA GA
30353-0062
US

V. Phone/Fax

Practice location:
  • Phone: 843-376-2670
  • Fax: 843-376-2790
Mailing address:
  • Phone: 843-695-6071
  • Fax: 843-569-5879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2606
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: