Individual
CASEY JEAN BOLTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
725 JESSE JEWELL PKWY SE, GAINESVILLE, GA 30501-3834
(678) 207-4373
(770) 533-4727
Mailing address
PO BOX 658, GAINESVILLE, GA 30503-0658
(770) 718-1122
(770) 533-4786
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
7500
GA
363AM0700X
Medical Physician Assistant
Primary
7500
GA
363AS0400X
Surgical Physician Assistant
7500
GA
Other
Enumeration date
03/24/2015
Last updated
03/03/2022
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