Provider Demographics
NPI:1487644050
Name:BOLTON, JAMES P (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:P
Last Name:BOLTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1751 GUNBARREL ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421
Mailing Address - Country:US
Mailing Address - Phone:423-697-1857
Mailing Address - Fax:423-697-7564
Practice Address - Street 1:1751 GUNBARREL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7177
Practice Address - Country:US
Practice Address - Phone:423-697-1857
Practice Address - Fax:423-697-7564
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD0000017733207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0129066OtherTNCARE SELECT
TN0129066OtherBLUECARD
TN3029583Medicaid
TN0129066OtherBLUECROSS BLUESHIELD/TN
TN0129066OtherBLUECARE
TN0129066OtherTNCARE SELECT
A99351Medicare UPIN