Provider Demographics
NPI:1043432164
Name:BOSS, JAMES LARRY (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LARRY
Last Name:BOSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 LESLIE DR
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-2406
Mailing Address - Country:US
Mailing Address - Phone:770-459-5179
Mailing Address - Fax:
Practice Address - Street 1:517 LESLIE DR
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-2406
Practice Address - Country:US
Practice Address - Phone:770-459-5179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA009437207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine