| Gary G. Bolton, M. D., P. A. | |
|
305 Highland Park Cove Ridgeland MS 39157-6059 | |
| (601) 206-9433 | |
| Not Available |
| Full Name | Gary G. Bolton, M. D., P. A. |
|---|---|
| Speciality | Clinic/Center |
| Location | 305 Highland Park Cove, Ridgeland, Mississippi |
| Authorized Official Name and Position | Gary G Bolton (PRESIDENT) |
| Authorized Official Contact | 6012069433 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gary G. Bolton, M. D., P. A. 305 Highland Park Cove Ridgeland MS 39157-6059 Ph: () - | Gary G. Bolton, M. D., P. A. 305 Highland Park Cove Ridgeland MS 39157-6059 Ph: (601) 206-9433 |
| NPI Number | 1205067188 |
|---|---|
| Provider Enumeration Date | 07/27/2009 |
| Last Update Date | 07/27/2009 |
| Medicare PECOS PAC ID | 7810031630 |
|---|---|
| Medicare Enrollment ID | O20100217000639 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205067188 | NPI | - | NPPES |
| 00111886 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 10243 (Mississippi) | Primary |
| Provider Name | Gary Glenn Bolton |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1972620797 PECOS PAC ID: 5395889117 Enrollment ID: I20100217000611 |
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