Provider Demographics
NPI:1649403080
Name:BOULDIN, CRISTI LEE (DPM)
Entity Type:Individual
Prefix:DR
First Name:CRISTI
Middle Name:LEE
Last Name:BOULDIN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:CRISTI
Other - Middle Name:LEE
Other - Last Name:WART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:108 N SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-1563
Mailing Address - Country:US
Mailing Address - Phone:931-728-3988
Mailing Address - Fax:931-728-6530
Practice Address - Street 1:108 N SPRING ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-1563
Practice Address - Country:US
Practice Address - Phone:931-728-3988
Practice Address - Fax:931-728-6530
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006148213ES0103X
TN727213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery