Individual
RUSSELL JAY BOZEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10929 US HIGHWAY 301 S, SUITE 111, STATESBORO, GA 30458-7774
(912) 764-7839
(912) 489-1519
Mailing address
10929 US HIGHWAY 301 S, SUITE 111, STATESBORO, GA 30458-7774
(912) 764-7839
(912) 489-1519
Taxonomy
Speciality
Code
Description
License number
State
1835G0303X
Geriatric Pharmacist
Primary
14782
GA
Other
Enumeration date
09/13/2007
Last updated
09/13/2007
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