MEDICARE: JONELL HAMILTON BOLTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	207163	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144529959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONELL HAMILTON BOLTON

Provider Business Mailing Address
First Line	:	5000 O'DONOVAN BLVD
Second Line	:	SUITE 404
City	:	WALKER
State	:	LA
Zip	:	70785-6351
Country	:	US
Telephone Number	:	225-271-6550
Fax Number	:	225-271-6551

Provider Business Practice Location Address
First Line	:	5000 O'DONOVAN BLVD
Second Line	:	SUITE 404
City	:	WALKER
State	:	LA
Zip	:	70785-6351
Country	:	US
Telephone Number	:	225-271-6550
Fax Number	:	225-271-6551

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2011
Last Update Date	:	01/15/2021

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Directions to “ JONELL HAMILTON BOLTON ” Practice Location

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