Raeonda Bullard, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

93170 Issued in GA

Practice address

6095 Professional Pkwy Ste A210
Douglasville, GA 30134-5611

Phone

(770) 949-4188

Fax

(770) 949-1614

NPI assigned

Jun 8, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Raeonda Williams Former name

Electronic endpoints 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

93.93 of 100Reported as apm

Quality

82.14

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Wellstar Medical Group, LLC

  • Family Medicine Physician
  • Kennesaw, GA
  • NPI 1558664003

  GA

  Medicare reassignment NPD
• Wellstar Medical Group, LLC

  • Multi-Specialty Clinic/Center
  • Marietta, GA
  • NPI 1275992240
  NPD
• Atlanta Women'S Health Group, P.C.

  • Specialist
  • Atlanta, GA
  • NPI 1174501902
  NPD (past)
• Douglas Hospital, Inc.

  • General Acute Care Hospital
  • Douglasville, GA
  • NPI 1649247974
  NPD (past)

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

{
    "created_epoch": "1528416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727308800000",
    "number": "1144713652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6095 PROFESSIONAL PKWY STE A210",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301345611",
            "telephone_number": "770-949-4188",
            "fax_number": "770-949-1614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6095 PROFESSIONAL PKWY STE A210",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301345611",
            "telephone_number": "770-949-4188",
            "fax_number": "770-949-1614"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2029 Pernoshal Ct",
            "address_purpose": "LOCATION",
            "city": "Dunwoody",
            "state": "GA",
            "postal_code": "303386405",
            "country_code": "US",
            "telephone_number": "770-730-0451",
            "fax_number": "770-730-0141",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BULLARD",
        "first_name": "RAEONDA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-08",
        "last_updated": "2024-09-26",
        "certification_date": "2024-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "010079",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "93170",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300034164A",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rbullard555433@directwellstar.org",
            "affiliation": "N",
            "address_1": "6095 Professional Pkwy Ste A210",
            "city": "Douglasville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301345611",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "RAEONDA",
            "last_name": "WILLIAMS",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kent Buchanan, PT
• Ruth Buckley
• Rosalind Buckner
• Tri Bui, RPH
• Cory Buice, DPT
• William G Bumgarner, DDS
• Kenneth Desmond Bunn, D.M.D.
• Gina Marie Burbank, FNP-C
• Jessica Burger, RBT
• Gabrielle Marie Burholt, MA, NCC, LAPC

• Obstetrics & Gynecology Physician in Douglasville, GA
• Providers in Douglasville, GA by specialty
• Obstetrics & Gynecology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.