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DR. HONORIO R BULOS M.D.,F.A.A.P.
Adolescent Medicine >> Pediatrics >> Allopathic & Osteopathic PhysiciansRegistrant NPI Number: 1497712939
Individual Registrant:DR. HONORIO R BULOS M.D.,F.A.A.P.
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
300 DAWSON COMMONS CIR STE 320 DAWSONVILLE, GA 30534-6268 US
Tel: 706-216-2770 Fax: 706-216-2944
Tel: 706-216-2770 Fax: 706-216-2944
Contact information for business:
300 DAWSON COMMONS CIR STE 320 DAWSONVILLE, GA 30534-6268 US
Tel: 706-216-2770 Fax: 706-216-2944
Tel: 706-216-2770 Fax: 706-216-2944
Registration Information:
NPI: 1497712939
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 2080A0000X | Allopathic & Osteopathic Physicians Pediatrics Adolescent Medicine | GA | 48029 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| AMERIGROUP TLC | 10049707 | GA | 01 |
| BCBS OF GA | 52837775 | GA | 01 |
| AMERIGROUP | 10032539 | GA | 01 |
| 000862584B | GA | 05 | |
| WELLCARE | 328286 | GA | 01 |
| WELLCARE TLC | 341290 | GA | 01 |
| 000862584C | GA | 05 | |
| PEACHSTATE | 000862584B | GA | 01 |
