Individual
AMANDA BOULOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1371 CHURCH STREET EXT NE, SUITE 200, MARIETTA, GA 30060-7913
(678) 481-0579
Mailing address
1551 JANMAR RD, SNELLVILLE, GA 30078-5606
(470) 579-5600
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
12976
GA
Other
Enumeration date
09/15/2023
Last updated
04/28/2025
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