Provider Demographics
NPI:1013915388
Name:BULLOCK, SONYA SIMMONS (PA-C)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:SIMMONS
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 TARBORO STREET SW STE 103
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893
Mailing Address - Country:US
Mailing Address - Phone:252-308-0686
Mailing Address - Fax:
Practice Address - Street 1:6321 DEANS STREET BAILEY PRIMARY CARE
Practice Address - Street 2:
Practice Address - City:BAILEY
Practice Address - State:NC
Practice Address - Zip Code:27807
Practice Address - Country:US
Practice Address - Phone:252-235-4181
Practice Address - Fax:252-308-0872
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104090363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical