Healthcare Provider Details

I. General information

NPI: 1215248604
Provider Name (Legal Business Name): JAMES G BORON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 01/07/2022
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 PARKWAY DR NE
ATLANTA GA
30312-1212
US

IV. Provider business mailing address

805 SANDY PLAINS RD MEDICAL STAFF SERVICES
MARIETTA GA
30066-6340
US

V. Phone/Fax

Practice location:
  • Phone: 404-265-4411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number036.137090
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberME148845
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: