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General NPI Number Information
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NPI Number | 1770689101
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Entity Type | Individual
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Provider Name | THERESA BULLARD MD
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Gender | Female
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | 6688 NC HIGHWAY 41 N
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City | LUMBERTON
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State | NC
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Zip | 28358-2501
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Country | US
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Telephone | 910-618-9260
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Fax | 910-737-6505
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Provider Business Mailing Address
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Address Line | 450 COUNTRY CLUB RD
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City | LUMBERTON
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State | NC
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Zip | 28360-9494
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Country | US
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Telephone | 910-272-1230
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Fax | 910-738-8230
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 9900782
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License Number State | NC
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