MEDICARE: DR. ERIN ELIZABETH BOLEN MD

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	98938	GA

General Provider Information

NPI Number	:	1174103964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIN ELIZABETH BOLEN MD

Provider Business Mailing Address
First Line	:	2015 UPPERGATE DRIVE NE, 5TH FLOOR
Second Line	:	ATTN: NEONATOLOGY-PERINATAL MEDICINE FELLOWSHIP PROGRAM
City	:	ATLANTA
State	:	GA
Zip	:	30322
Country	:	US
Telephone Number	:	404-727-5765
Fax Number	:	404-727-3236

Provider Business Practice Location Address
First Line	:	2015 UPPERGATE DRIVE NE 5TH FLOOR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-4619
Country	:	US
Telephone Number	:	404-727-5765
Fax Number	:

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

Provider Enumeration Date	:	04/14/2021
Last Update Date	:	06/24/2024

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