Provider Demographics
NPI:1497712939
Name:BULOS, HONORIO R (MD,FAAP)
Entity Type:Individual
Prefix:DR
First Name:HONORIO
Middle Name:R
Last Name:BULOS
Suffix:
Gender:M
Credentials:MD,FAAP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:300 DAWSON COMMONS CIR
Mailing Address - Street 2:STE 320
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-6268
Mailing Address - Country:US
Mailing Address - Phone:706-216-2770
Mailing Address - Fax:706-216-2944
Practice Address - Street 1:300 DAWSON COMMONS CIR
Practice Address - Street 2:STE 320
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-6268
Practice Address - Country:US
Practice Address - Phone:706-216-2770
Practice Address - Fax:706-216-2944
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA480292080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000862584BMedicaid
GA341290OtherWELLCARE TLC
GA52837775OtherBCBS OF GA
GA000862584BOtherPEACHSTATE
GA000862584CMedicaid
GA10032539OtherAMERIGROUP
GA328286OtherWELLCARE
GA10049707OtherAMERIGROUP TLC
GA341290OtherWELLCARE TLC