Individual
BOLA GABRIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5100 BROOKSTONE CT, ANTIOCH, TN 37013-5687
(615) 569-4067
Mailing address
5100 BROOKSTONE CT, ANTIOCH, TN 37013-5687
(615) 569-4067
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
05/04/2017
Last updated
05/04/2017
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