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General NPI Number Information
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NPI Number | 1679601090
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Entity Type | Individual
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Provider Name | ELIZABETH BOSWELL M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1355 PEACHTREE ST NE STE 580
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City | ATLANTA
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State | GA
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Zip | 30309-3232
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Country | US
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Telephone | 404-885-9030
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Fax | 404-885-9047
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Provider Business Mailing Address
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Address Line | 62 PARK LN NE
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City | ATLANTA
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State | GA
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Zip | 30309-2753
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Country | US
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Telephone | 404-892-5976
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Fax | 404-885-9047
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036504
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License Number State | GA
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