Individual
NORMAN BOSTIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CTRS
Contact information
Practice address
400 W FRANKLIN ST, MILLEDGEVILLE, GA 31061-3251
(478) 258-3882
Mailing address
2404 RIVER RIDGE RD NE, MILLEDGEVILLE, GA 31061-8702
(478) 258-3882
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
58969
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
58969
CTRS
—
Enumeration date
10/04/2019
Last updated
10/04/2019
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