Individual
NICHOLAS M BOULIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1365 CLIFTON RD NE # CLINICB, ATLANTA, GA 30322
(404) 727-2247
Mailing address
1365B CLIFTON RD NE STE B6200, ATLANTA, GA 30322-1013
(404) 727-2247
(404) 712-8576
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
059605
GA
207T00000X
Neurological Surgery Physician
35079749B
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2258775
—
OH
Enumeration date
04/11/2006
Last updated
10/15/2018
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