Individual
MR. PAUL A BOLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
110 OSIGIAN BLVD, WARNER ROBINS, GA 31088-7880
(478) 953-2922
(478) 953-2927
Mailing address
1138 LUCKY DEBONAIR DR, MACON, GA 31210-1212
(478) 953-2922
(478) 953-2927
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
000006
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000006
STATE O&P LICENSE
GA
01
—
CPO 1780
ABC CERT PROSTH & ORTHO
GA
Enumeration date
11/30/2006
Last updated
07/08/2007
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