Organization
GARY G. BOLTON, M. D., P. A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY G BOLTON M. D. (PRESIDENT)
(601) 206-9433
Entity
Organization
Contact information
Practice address
305 HIGHLAND PARK COVE, RIDGELAND, MS 39157-6059
(601) 206-9433
Mailing address
305 HIGHLAND PARK COVE, RIDGELAND, MS 39157-6059
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
10243
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00111886
—
MS
Enumeration date
07/27/2009
Last updated
07/27/2009
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