Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | RN208631 | GA |
NPI | 1760992150 |
---|---|
Provider Name | Erica Ann Bullard |
First Address | Atlanta, GA 30303-3032 |
Second Address | Atlanta, GA 30303-3032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2017 |
Last Update Date | 25/06/2021 |