Provider Demographics
NPI:1831731850
Name:BULLARD, JOEY (FNP-BC)
Entity type:Individual
Prefix:
First Name:JOEY
Middle Name:
Last Name:BULLARD
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-5473
Mailing Address - Country:US
Mailing Address - Phone:229-236-0831
Mailing Address - Fax:229-236-0871
Practice Address - Street 1:462 ELMA G MILES PKWY STE 102A
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-4000
Practice Address - Country:US
Practice Address - Phone:912-369-9310
Practice Address - Fax:912-877-3102
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN239540363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner