Individual
GARY F BOULOUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, DDS
Contact information
Practice address
1365 CLIFTON RD NE, ATLANTA, GA 30322-1013
(404) 778-5000
Mailing address
1365B CLIFTON RD NE, SUITE 2300, ATLANTA, GA 30322-1013
(404) 778-4500
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
057350
GA
Other
Enumeration date
05/22/2006
Last updated
11/14/2014
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