Provider Demographics
NPI:1609865021
Name:BOSWELL, VINCENT EVERETT (MD, PC)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:EVERETT
Last Name:BOSWELL
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:285 BOULEVARD NE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-4205
Mailing Address - Country:US
Mailing Address - Phone:404-588-1272
Mailing Address - Fax:404-588-1275
Practice Address - Street 1:285 BOULEVARD NE
Practice Address - Street 2:SUITE 115
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-4205
Practice Address - Country:US
Practice Address - Phone:404-588-1272
Practice Address - Fax:404-588-1275
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0-35820207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA884300OtherBLUECROSS BLUESHEILD
GA20BBDWTMedicare ID - Type Unspecified
GAE70610Medicare UPIN