Gary G. Bolton, M. D., P. a.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

10243 Issued in MS

Legal business name

GARY G. BOLTON, M. D., P. A.

Practice address

305 Highland Park Cove
Ridgeland, MS 39157-6059

Phone

(601) 206-9433

NPI assigned

Jul 27, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Gary G Bolton, M. D.NPI 1972620797

Title

President

Phone

(601) 206-9433

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

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.

• Gary Glenn Bolton, M. D.

  • Dermatology Physician
  • Ridgeland, MS
  • NPI 1972620797
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1248652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248652800000",
    "number": "1205067188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 HIGHLAND PARK COVE",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391576059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 HIGHLAND PARK COVE",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391576059",
            "telephone_number": "601-206-9433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARY G. BOLTON, M. D., P. A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-27",
        "last_updated": "2009-07-27",
        "status": "A",
        "authorized_official_last_name": "BOLTON",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "601-206-9433",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M. D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MS",
            "license": "10243",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00111886",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lindsey Accardo Fyke, PT
• G.F. Televet
• Shakeria Gainwell
• Laura Michelle Gans, SLP
• Bonnie Henkelmann Garrard, SLP
• Christen Hancock Gates, PLPC
• Lynda Thomas Gates, CCC/SLP
• Anna Gatewood, FNP
• Courtney Elizabeth Gaughf, NP
• Susan Denice Gautreau

• Clinic/Center in Ridgeland, MS
• Providers in Ridgeland, MS by specialty
• Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2009; 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.