Provider Demographics
NPI:1881089993
Name:BULLON, TONY (MD)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:BULLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 UMBERLAND DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30340-4904
Mailing Address - Country:US
Mailing Address - Phone:817-526-4014
Mailing Address - Fax:
Practice Address - Street 1:1834 CLAIRMONT RD STE 100
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033
Practice Address - Country:US
Practice Address - Phone:404-634-4443
Practice Address - Fax:404-634-4444
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN58159207P00000X
GA76895207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine