Individual
JAMES BRIAN BOULWARE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, ATC, OTC, LAT
Contact information
Practice address
475 BRUCE WAY SW, LILBURN, GA 30047-3025
(678) 764-6364
Mailing address
1014 SYCAMORE DR, SUITE B, DECATUR, GA 30030-1644
(404) 299-1700
(404) 299-1616
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT001328
GA
Other
Enumeration date
02/22/2007
Last updated
05/25/2011
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