Colette Devona Bullock, DO

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

75415 Issued in GA

Practice address

5422 Cumming Hwy Ste 104
Sugar Hill, GA 30518-7027

Phone

(678) 466-9193

Fax

(877) 991-5350

NPI assigned

Jul 25, 2007

Last updated

Oct 8, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Dr. Colette Devona Taylor Former name

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

Specialty

Internal Medicine

Education

Philadelphia College of Osteopathic Medicine, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: colettebullock@napc.allscriptsdirect.net

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

• Legacy Medical, LLC

  • Internal Medicine Physician
  • Sugar Hill, GA
  • NPI 1750846648

  Single Specialty

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1185321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665187200000",
    "number": "1164612370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5422 CUMMING HWY STE 104",
            "city": "SUGAR HILL",
            "state": "GA",
            "postal_code": "305187027",
            "telephone_number": "678-765-7147",
            "fax_number": "877-991-5350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5422 CUMMING HWY STE 104",
            "city": "SUGAR HILL",
            "state": "GA",
            "postal_code": "305187027",
            "telephone_number": "678-466-9193",
            "fax_number": "877-991-5350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLOCK",
        "first_name": "COLETTE",
        "middle_name": "DEVONA",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-07-25",
        "last_updated": "2022-10-08",
        "certification_date": "2022-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "OS015213",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MB08802400",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "75415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COLETTE",
            "last_name": "TAYLOR",
            "middle_name": "DEVONA",
            "prefix": "DR.",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Laura Arcuragi Brenes, LPC
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• Avril Janis Angela Brown, R.N.
• Sharon R Bryan, RPH
• Lauren Bryson
• Karen Marie Burgbacher, M.S.P.T.
• Diane Campbell, PHD
• Paul Carroll, ED.S
• Nomiki Nikitadena Catsulis, APRN, PNP-PC
• Melissa Sharon Chason, F.N.P.

• Internal Medicine Physician in Sugar Hill, GA
• Providers in Sugar Hill, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2022; 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.