Individual
MR. KENNETH BOSTIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1061 HARMON AVE, WINN ARMY COMMUNITY HOSPITAL STE1D03, FORT STEWART, GA 31314-5641
(912) 435-5254
Mailing address
1061 HARMON AVE, WINN ARMY COMMUNITY HOSPITAL STE1D03, FORT STEWART, GA 31314-5641
(912) 435-5254
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
003528
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
641480416A
—
GA
05
—
641480416B
—
GA
05
—
641480416C
—
GA
Enumeration date
01/10/2007
Last updated
02/23/2021
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