Boulware P.a. Inc

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

BOULWARE P.A. INC

Practice address

216 N Main St
Madison, GA 30650-1313

Phone

(706) 343-4100

NPI assigned

Jan 28, 2022

Last updated

Jan 28, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ronald Glen Boulware, MDNPI 1033189469

Title

Physician

Phone

(813) 546-0468

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ronald Boulware, MD

  • Family Medicine Physician
  • Madison, GA
  • NPI 1033189469
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1643328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643328000000",
    "number": "1073266292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 788",
            "city": "MADISON",
            "state": "GA",
            "postal_code": "306500788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 N MAIN ST",
            "city": "MADISON",
            "state": "GA",
            "postal_code": "306501313",
            "telephone_number": "706-343-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULWARE P.A. INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-28",
        "last_updated": "2022-01-28",
        "certification_date": "2022-01-28",
        "status": "A",
        "authorized_official_last_name": "BOULWARE",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "GLEN",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "813-546-0468",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bella256 Boutique LLC
• Beth McDonald LPC LLC
• Bethany Respite Care LLC
• Bloom Pediatrics
• Christine Bohlen, NP
• Ronald Boulware, MD
• Jennifer V Bowers, PA-C
• Whitney Lee Bruniera, PT
• Vince Campbell, D.C.
• Child & Adolescent Resource, P.C.

• Primary Care Clinic/Center in Madison, GA
• Providers in Madison, GA by specialty
• Primary Care Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.