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General NPI Number Information
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NPI Number | 1558320119
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Entity Type | Individual
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Provider Name | WILLIAM TODD BOLEMAN MD
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Gender | Male
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Dates
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Enumeration Date | 03/22/2006
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Last Update Date | 10/11/2012
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Provider Practice Location Address
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Address Line | 690 DALLAS HWY SUITE 101
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City | VILLA RICA
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State | GA
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Zip | 30180-1264
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Country | US
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Telephone | 770-459-0620
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Fax | 770-456-7604
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Provider Business Mailing Address
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Address Line | 690 DALLAS HWY SUITE 101
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City | VILLA RICA
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State | GA
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Zip | 30180-1264
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Country | US
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Telephone | 770-459-0620
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Fax | 770-456-7604
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | MD-050257-L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD-050257-L
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 068372
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License Number State | GA
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