Provider Demographics
NPI:1104216373
Name:GAYE-BULLARD, NGONEH
Entity Type:Individual
Prefix:MRS
First Name:NGONEH
Middle Name:
Last Name:GAYE-BULLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3207 POST WOODS DR
Mailing Address - Street 2:B
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3445
Mailing Address - Country:US
Mailing Address - Phone:401-263-6467
Mailing Address - Fax:
Practice Address - Street 1:3207 POST WOODS DR
Practice Address - Street 2:B
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3445
Practice Address - Country:US
Practice Address - Phone:401-263-6467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW006339104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker