Provider Demographics
NPI:1396784971
Name:BULLOCK, SALLY (MD)
Entity type:Individual
Prefix:DR
First Name:SALLY
Middle Name:
Last Name:BULLOCK
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:PO BOX 1227
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-1227
Mailing Address - Country:US
Mailing Address - Phone:931-451-7946
Mailing Address - Fax:931-451-7934
Practice Address - Street 1:211 COOL SPRINGS BLVD.
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067
Practice Address - Country:US
Practice Address - Phone:615-778-6800
Practice Address - Fax:615-778-6822
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15210207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3009310Medicaid
SD3009316Medicare ID - Type Unspecified