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Individual

CHARLES BOLING

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
3780 EISENHOWER PKWY, MACON, GA 31206-0800
(478) 633-5500
(478) 784-3550
Mailing address
598 3RD ST, MACON, GA 31201-3357
(478) 633-6706
(478) 633-5384

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
003551
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100002808A
GA
Enumeration date
02/24/2006
Last updated
07/08/2007
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