Provider Demographics
NPI:1255347639
Name:BULLENS-BORROW, AMY E (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:BULLENS-BORROW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ELIZABETH
Other - Last Name:BORROW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-535-7445
Practice Address - Street 1:1270 FRIENDSHIP RD
Practice Address - Street 2:
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-5630
Practice Address - Country:US
Practice Address - Phone:678-207-4477
Practice Address - Fax:678-207-4478
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056413207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA587774OtherWELLCARE
GA310272239CMedicaid
GA310272239DMedicaid
GAP00956721OtherMEDICARE RAILROAD GROUP #CC4177
GA01417999OtherAMERIGROUP
GA52176459OtherBCBS
GA7337297OtherAETNA
GA310272239GMedicaid
GA310272239FMedicaid
GA2672603OtherCIGNA
GA310272239EMedicaid
GA310272239GMedicaid
GA310272239DMedicaid