Provider Demographics
NPI:1275971350
Name:BULLA, ANNA LUCIA (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:LUCIA
Last Name:BULLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 LANIER 400 PKWY
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2539
Mailing Address - Country:US
Mailing Address - Phone:770-205-1294
Mailing Address - Fax:770-887-4597
Practice Address - Street 1:765 LANIER 400 PKWY
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2539
Practice Address - Country:US
Practice Address - Phone:770-205-1294
Practice Address - Fax:770-887-4597
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10045430207Q00000X
GA76949207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine