Individual
DR. WILLIAM TODD BOLEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
690 DALLAS HWY, SUITE 101, VILLA RICA, GA 30180-1264
(770) 459-0620
(770) 456-7604
Mailing address
690 DALLAS HWY, SUITE 101, VILLA RICA, GA 30180-1264
(770) 459-0620
(770) 456-7604
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
068372
GA
207K00000X
Allergy & Immunology Physician
MD-050257-L
PA
208000000X
Pediatrics Physician
MD-050257-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
GA
Enumeration date
03/22/2006
Last updated
10/11/2012
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