Provider Demographics
NPI:1255443214
Name:BOLDEN, EDYTHE
Entity type:Individual
Prefix:
First Name:EDYTHE
Middle Name:
Last Name:BOLDEN
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 1:2003 MOODY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-2305
Mailing Address - Country:US
Mailing Address - Phone:256-259-3091
Mailing Address - Fax:
Practice Address - Street 1:508 GREGORY ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-4239
Practice Address - Country:US
Practice Address - Phone:256-256-1774
Practice Address - Fax:256-259-0761
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist