Individual
DR. KENNETH L BOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
820 MAPLE ST, CARROLLTON, GA 30117-3626
(678) 390-7915
Mailing address
PO BOX 728, BREMEN, GA 30110-0728
(770) 537-1234
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
052425
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1861915647
GROUP NPI
GA
05
—
277491774A
—
GA
Enumeration date
02/21/2006
Last updated
03/20/2025
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