MEDICARE: AMY E BULLENS-BORROW MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	056413	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00956721	OTHER	GA	MEDICARE RAILROAD GROUP #CC4177

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	587774	OTHER	GA	WELLCARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	01417999	OTHER	GA	AMERIGROUP
6	52176459	OTHER	GA	BCBS
7	7337297	OTHER	GA	AETNA
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	2672603	OTHER	GA	CIGNA
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255347639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY E BULLENS-BORROW MD

Provider Business Mailing Address
First Line	:	PO BOX 658
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30503-0658
Country	:	US
Telephone Number	:	770-718-1122
Fax Number	:	770-535-7445

Provider Business Practice Location Address
First Line	:	1270 FRIENDSHIP RD
Second Line	:
City	:	BRASELTON
State	:	GA
Zip	:	30517-5630
Country	:	US
Telephone Number	:	678-207-4477
Fax Number	:	678-207-4478

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	02/27/2019

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Directions to “ AMY E BULLENS-BORROW MD” Practice Location

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