# BOULEVARD FAMILY PRACTICE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Boulevard Family Practice
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194133884
- **Authorized official:** DR. THOMAS WEINER MBBS (PHYSICIAN)
- **Authorized official phone:** (706) 850-6134

## Contact information

- **Practice address:** 855 W BROAD ST STE A, ATHENS, GA 30601-2511
- **Practice address phone:** (706) 850-6134
- **Practice address fax:** (706) 850-6318
- **Mailing address:** 855 W BROAD ST STE A, ATHENS, GA 30601-2511
- **Mailing address phone:** (706) 850-6134
- **Mailing address fax:** (706) 850-6318

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/26/2014
- **Last updated:** 07/28/2020