Provider Demographics
NPI:1174684443
Name:BULLOCK-MORLEY, ANITA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:
Last Name:BULLOCK-MORLEY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1892 HOSEA L WILLIAMS DRIVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-2509
Mailing Address - Country:US
Mailing Address - Phone:404-720-4278
Mailing Address - Fax:
Practice Address - Street 1:1892 HOSEA L WILLIAMS DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317-2239
Practice Address - Country:US
Practice Address - Phone:404-720-4278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005096235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000918255BMedicaid