MEDICARE: MISS RAMONA CAROL BOLIN 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	363A00000X	Physician Assistant	PA275	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457398257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS RAMONA CAROL BOLIN PA-C

Provider Business Mailing Address
First Line	:	204 HOLMAN DR
Second Line	:
City	:	HEADLAND
State	:	AL
Zip	:	36345-2307
Country	:	US
Telephone Number	:	334-693-3336
Fax Number	:	334-693-2553

Provider Business Practice Location Address
First Line	:	204 HOLMAN DR
Second Line	:
City	:	HEADLAND
State	:	AL
Zip	:	36345-2307
Country	:	US
Telephone Number	:	334-693-3336
Fax Number	:	334-693-2553

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

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	07/08/2007

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