MEDICARE: MR. BENJAMIN KEITH BOLES PA-C

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	363AM0700X	Medical Physician Assistant	0010-04882	NC
2	363A00000X	Physician Assistant	0010-04882	NC

General Provider Information

NPI Number	:	1447676788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BENJAMIN KEITH BOLES PA-C

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7210 VILLAGE MEDICAL CIR STE 110
Second Line	:
City	:	CLEMMONS
State	:	NC
Zip	:	27012-8029
Country	:	US
Telephone Number	:	336-893-2400
Fax Number	:

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

Provider Enumeration Date	:	03/11/2014
Last Update Date	:	08/07/2024

Similar Medicare Providers

1932562154 — DANIEL AVERY PIERCE
Practice Location Address:

7210 VILLAGE MEDICAL CIR
CLEMMONS, NC
27012-8029

Practice Phone: 336-893-2400
Practice Fax: 336-893-2410

1508824491 — DR. CHARLES EDWARD CRAVEN JR. M.D.
Practice Location Address:

7210 VILLAGE MEDICAL CIR STE 110
CLEMMONS, NC
27012-8029

Practice Phone: 336-893-2400
Practice Fax: 336-893-2410

1356766810 — SARAH ELIZABETH WALLS
Practice Location Address:

7210 VILLAGE MEDICAL CIR , STE 310
CLEMMONS, NC
27012-8029

Practice Phone: 336-277-4075
Practice Fax:

1548661606 — NOVANT HEALTH MEDICAL GROUP LLC
Practice Location Address:

7210 VILLAGE MEDICAL CIR STE 110
CLEMMONS, NC
27012-8029

Practice Phone: 336-893-2400
Practice Fax: 336-893-2410

1730716267 — FOUNDATION HEALTH SYSTEMS CORP
Practice Location Address:

7210 VILLAGE MEDICAL CIR STE 115
CLEMMONS, NC
27012-8029

Practice Phone: 336-893-2460
Practice Fax:

1306786413 — JOANNE CLARKIN GONZALEZ SLP
Practice Location Address:

8155 WHITMORE COVE LN
CLEMMONS, NC
27012-8881

Practice Phone: 336-995-2046
Practice Fax:

Directions to “ MR. BENJAMIN KEITH BOLES PA-C” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.