Individual
BONNIE KRISTINE BOLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
690 DALLAS HWY, SUITE 207-A, VILLA RICA, GA 30180-1264
(770) 456-3380
(770) 456-3785
Mailing address
119 AMBULANCE DRIVE, SUITE 202, CARROLLTON, GA 30117-1476
(770) 456-3380
(770) 456-3785
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
036927
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000682437F
—
GA
05
—
000682437H
—
GA
Enumeration date
08/11/2005
Last updated
10/11/2012
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