Provider Demographics
NPI:1942469861
Name:BULLARD, JAMES ROGER (MD RETIRED)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ROGER
Last Name:BULLARD
Suffix:
Gender:M
Credentials:MD RETIRED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14727
Mailing Address - Street 2:707 SOMERSET WAY
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909
Mailing Address - Country:US
Mailing Address - Phone:706-738-5612
Mailing Address - Fax:706-738-0099
Practice Address - Street 1:707 SOMERSET WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-3146
Practice Address - Country:US
Practice Address - Phone:706-738-5612
Practice Address - Fax:706-738-0099
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8721207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology