Provider Demographics
NPI:1841453701
Name:BULLA, SUSAN D (MT (ASCP) EMT-I)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:D
Last Name:BULLA
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Gender:F
Credentials:MT (ASCP) EMT-I
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Mailing Address - Street 1:86 SOUTH COBB DRIVE
Mailing Address - Street 2:MAIL ZONE 0454
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-0454
Mailing Address - Country:US
Mailing Address - Phone:770-494-4131
Mailing Address - Fax:770-494-3551
Practice Address - Street 1:86 SOUTH COBB DRIVE
Practice Address - Street 2:MAIL ZONE 0454
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-0454
Practice Address - Country:US
Practice Address - Phone:770-494-4131
Practice Address - Fax:770-494-3551
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
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Provider Licenses
StateLicense IDTaxonomies
MT (ASCP) 76594246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist