Provider Demographics
NPI:1922793538
Name:BOLIA, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:BOLIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1271 PEACHTREE VW NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3411
Mailing Address - Country:US
Mailing Address - Phone:404-578-0454
Mailing Address - Fax:
Practice Address - Street 1:400 EMBASSY ROW STE 110
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5723
Practice Address - Country:US
Practice Address - Phone:404-578-0454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer