Provider Demographics
NPI:1770554347
Name:BOLING, JAMES FRED (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:FRED
Last Name:BOLING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 MOUNTAIN LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2963
Mailing Address - Country:US
Mailing Address - Phone:770-889-4791
Mailing Address - Fax:
Practice Address - Street 1:105 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2381
Practice Address - Country:US
Practice Address - Phone:770-887-9369
Practice Address - Fax:770-887-1907
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023568207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00251336AMedicaid
GAD39437Medicare UPIN