Individual
DR. BILLY BOLDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1405 STRONG AVE, GREENWOOD, MS 38930-4035
(662) 459-7030
(662) 459-1104
Mailing address
PO BOX 1410, ATTN CLINIC ADMINISTRATION, GREENWOOD, MS 38935-1410
(662) 459-1187
(662) 459-1147
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
12903
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00113949
—
MS
Enumeration date
03/17/2006
Last updated
04/25/2008
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