Organization
BOULWARE P.A. INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RONALD GLEN BOULWARE MD (PHYSICIAN)
(813) 546-0468
Entity
Organization
Contact information
Practice address
216 N MAIN ST, MADISON, GA 30650-1313
(706) 343-4100
Mailing address
PO BOX 788, MADISON, GA 30650-0788
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
01/28/2022
Last updated
01/28/2022
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