Mary Anne Bullard, M.D.
Individual provider Active NPI Diagnostic Radiology Physician · Thomasville, GA
NPI 1730136268 · NPPES record last updated May 8, 2008
Key facts
- NPI
- 1730136268
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- License
- 048331 (GA)
- Practice address
- 915 Gordon Ave
Thomasville, GA 31792-6614 - Phone
- (229) 228-2000
- NPI assigned
- May 30, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 23
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Diagnostic Radiology
- Education
- Wayne State University School of Medicine, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Grady General Hospital
Hospital Authority of Mitchell County
Brooks County Hospital
John D Archbold Memorial Hospital Inc
Practice addresses (Care Compare)
1155 5TH St SE
Cairo, GA 39828-3142
Phone (229) 377-1150
90 E Stephens St
Camilla, GA 31730-1836
Phone (229) 336-5284
903 N Court St
Quitman, GA 31643-1315
Phone (229) 263-4171
915 Gordon Ave
Thomasville, GA 31792-6614
Phone (229) 228-2000
Hospital & facility affiliations
- Grady General Hospital
- Archbold Memorial Hospital
- Archbold Mitchell
- Archbold Brooks
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050805000435 | GA | Practitioner - Diagnostic Radiology | 9537198916 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 048331 | GA | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pathology Associates, P.C. | Current | Accepting new patients | |
| Grady General Hospital | Current |
Accepting new patients | |
| John D Archbold Memorial Hospital Inc | Current |
Accepting new patients | |
| Brooks County Hospital | Current |
Accepting new patients | |
| Hospital Authority of Mitchell County | Current |
Accepting new patients |
Locations
630 Columbia St
Blakely, GA 39823
Phone (229) 723-4241
1155 5th St SE
Cairo, GA 39828
Phone (229) 226-3060
90 E Stephens St
Camilla, GA 31730
Phone (229) 200-4950
903 N Court St
Quitman, GA 31643
Phone (229) 263-4531
920 Cairo Rd
Thomasville, GA 31792
Phone (229) 228-8800
113 W Hansell St
Thomasville, GA 31792
Phone (229) 226-3060
915 Gordon Ave
Thomasville, GA 31792
Phone (229) 228-8575
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/66097e3b-7cef-4b96-acca-38bfaae85903/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | 048331 | GA | Yes |
Addresses
Primary practice location
915 Gordon Ave
Thomasville, GA 31792-6614
Mailing address
920 Cairo Rd
Thomasville, GA 31792-4255
Phone (229) 228-8800
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000856149K | Medicaid | GA |
Other providers in Thomasville, GA
- Donald Bruhn
- Melissa S Bruhn
- Kaylee Toole Bruner
- Alaura Legrace Bryant
- Aymen Yousuf Bukannan
- Patrice Gunter Bullock
- Sadie H Burke
- Jason Odell Burnette
- Jessica Burns
- Rachel Burns
All providers in Thomasville, GA · Diagnostic Radiology Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 8, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.