Provider Demographics
NPI:1205246899
Name:BOLES GLOBAL TELEPSYCHIATRY
Entity type:Organization
Organization Name:BOLES GLOBAL TELEPSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHEEDAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLES
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:912-921-8789
Mailing Address - Street 1:785 KING GEORGE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-9501
Mailing Address - Country:US
Mailing Address - Phone:912-318-8764
Mailing Address - Fax:
Practice Address - Street 1:785 KING GEORGE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-9501
Practice Address - Country:US
Practice Address - Phone:912-318-8764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-05
Last Update Date:2016-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN151817363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty