Individual
SHANNON LEIGH BOLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
931 LOWER FAYETTEVILLE RD STE J, NEWNAN, GA 30263-5790
(770) 253-0170
Mailing address
475 BARRINGTON GRANGE DR, SHARPSBURG, GA 30277-3640
(678) 697-5498
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
RN197974
GA
Other
Enumeration date
08/04/2017
Last updated
08/04/2017
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