Individual
ETTA WILCIA BOSS COLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
303 HARRIS INDUSTRIAL BLVD STE 3, VIDALIA, GA 30474-8854
(912) 537-9355
(123) 738-0969
Mailing address
303 HARRIS INDUSTRIAL BLVD STE 3, VIDALIA, GA 30474-8854
(912) 537-9355
(912) 373-8096
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
055541
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
588529933C
—
GA
Enumeration date
10/18/2006
Last updated
10/08/2024
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