Provider Demographics
NPI:1811006174
Name:VINCENT E. BOSWELL MD, P.C.
Entity Type:Organization
Organization Name:VINCENT E. BOSWELL MD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:EVERETT
Authorized Official - Last Name:BOSWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-588-1272
Mailing Address - Street 1:1776 PEACHTREE ST NW
Mailing Address - Street 2:SUITE 318N
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2307
Mailing Address - Country:US
Mailing Address - Phone:404-588-1272
Mailing Address - Fax:404-588-1275
Practice Address - Street 1:285 BOULEVARD NE STE 115
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-4207
Practice Address - Country:US
Practice Address - Phone:404-588-1272
Practice Address - Fax:404-588-1275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035820207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GABCBSOther884300
GAGRP7853Medicare PIN
GABCBSOther884300
GA5207810001Medicare NSC