MEDICARE: MR. JAMES MELVIN BOLDEN JR. RN

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	372500000X	Chore Provider	1000000007148	TN
2	372600000X	Adult Companion	1000000007148	TN
3	3747A0650X	Attendant Care Provider	1000000007148	TN
4	3747P1801X	Personal Care Attendant	1000000007148	TN
5	376J00000X	Homemaker	1000000007148	TN

General Provider Information

NPI Number	:	1407163223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES MELVIN BOLDEN JR. RN

Provider Business Mailing Address
First Line	:	3540 SUMMER AVE
Second Line	:	409
City	:	MEMPHIS
State	:	TN
Zip	:	38122-3600
Country	:	US
Telephone Number	:	901-490-2636
Fax Number	:

Provider Business Practice Location Address
First Line	:	3540 SUMMER AVE
Second Line	:	409
City	:	MEMPHIS
State	:	TN
Zip	:	38122-3600
Country	:	US
Telephone Number	:	901-490-2636
Fax Number	:

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

Provider Enumeration Date	:	09/01/2010
Last Update Date	:	09/01/2010

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