Individual provider Active NPI

Anna Bullis, NP

  • Nurse Practitioner
  • Roswell, GA
National Provider Identifier
1104494897
Registry record updated May 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN239431 Issued in GA
Practice address
3000 Hospital Blvd
Roswell, GA 30076-4915
Phone
(770) 751-2500
NPI assigned
Jun 17, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 26, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN239431 GA Primary
Emergency Registered Nurse 163WE0003X RN239431 GA

Addresses

Primary practice location

3000 Hospital Blvd
Roswell, GA 30076-4915

Mailing address

3000 Hospital Blvd
Roswell, GA 30076-4915
Phone (770) 751-2500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220105000116 GA Practitioner - Nurse Practitioner 6002207834 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergency Coverage LLCGroup PAC ID 3072412592, 761 clinicians

Practice addresses (Care Compare)

1266 Hwy 515 S
Jasper, GA 30143-4872
Phone (706) 692-2441

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Coverage Services, PC Nurse Practitioner CurrentSince May 1, 2022 Accepting new patients
Acs Primary Care Physicians - Southeast PC Nurse Practitioner CurrentSince Nov 1, 2021 Accepting new patients
Small Hospital Innovations LLC CurrentSince Jul 1, 2024 Accepting new patients
Emergency Coverage, LLC Nurse Practitioner CurrentSince May 1, 2024 Accepting new patients

Locations

1200 Memorial Dr
Dalton, GA 30720
Phone (706) 272-6115

1266 Highway 515 S
Jasper, GA 30143
Phone (706) 301-5350

2151 W Spring St
Monroe, GA 30655
Phone (770) 267-1792

11 Upper Riverdale Rd SW
Riverdale, GA 30274
Phone (770) 897-7277

501 Redmond Rd NW
Rome, GA 30165
Phone (706) 291-0291

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685059200000",
    "number": "1104494897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 HOSPITAL BLVD",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300764915",
            "telephone_number": "770-751-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 HOSPITAL BLVD",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300764915",
            "telephone_number": "770-751-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLIS",
        "first_name": "ANNA",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-17",
        "last_updated": "2023-05-26",
        "certification_date": "2023-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN239431",
            "primary": true
        },
        {
            "code": "163WE0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Emergency",
            "state": "GA",
            "license": "RN239431",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, GA

Sources for this page

Verify at the official NPI Registry.