Healthcare Provider Details

I. General information

NPI: 1861319311
Provider Name (Legal Business Name): JATOSJAH BOLSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 DUNWOODY PL
SANDY SPRINGS GA
30350-2519
US

IV. Provider business mailing address

76 OLD MILL CT
MILLEDGEVILLE GA
31061-6644
US

V. Phone/Fax

Practice location:
  • Phone: 614-407-8000
  • Fax:
Mailing address:
  • Phone: 478-456-6263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH035874
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: