William Todd Boleman, MD
Individual provider Active NPI Allergy & Immunology Physician · Villa Rica, GA
NPI 1558320119 · NPPES record last updated Oct 11, 2012
Key facts
- NPI
- 1558320119
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Allergy & Immunology Physician 207K00000X
- License
- 068372 (GA)
- Practice address
- 690 Dallas Hwy
Suite 101
Villa Rica, GA 30180-1264 - Phone
- (770) 459-0620
- Fax
- (770) 456-7604
- NPI assigned
- Mar 22, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Allergy/Immunology
- Education
- University of South Carolina School of Medicine, 1991
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Center for Allergy and Asthma of Georgia PC
Practice addresses (Care Compare)
223 W College St
Griffin, GA 30224-4120
Phone (770) 459-0620
3104 Creekside Village Dr NW
Suite 500
Kennesaw, GA 30144-2393
Phone (770) 459-0620
4586 Timber Ridge Dr
Suite 210
Douglasville, GA 30135-7514
Phone (770) 459-0620
5604 Wendy Bagwell Pkwy
Hiram, GA 30141-7819
Phone (770) 459-0620
690 Dallas Hwy
Suite 101
Villa Rica, GA 30180-1262
Phone (770) 459-0620
825 Dixie St
Carrollton, GA 30117-4415
Phone (770) 459-0620
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20121112000394 | GA | Practitioner - Allergy/Immunology |
4789835158 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD-050257-L | PA | MD | Allergy & Immunology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Center for Allergy and Asthma Southern Crescent | Allergy & Immunology | Current |
Accepting new patients |
| Center for Allergy & Asthma of Georgia PC | Allergy & Immunology | Current |
Accepting new patients |
Locations
3300 Old Milton Pkwy
Ste 125
Alpharetta, GA 30005
Phone (678) 287-7640
825 Dixie St
Carrollton, GA 30117
4586 Timber Ridge Dr
Ste 210
Douglasville, GA 30135
223 W College St
Griffin, GA 30224
5604 Wendy Bagwell Pkwy
Ste 900
Hiram, GA 30141
5604 Wendy Bagwell Pkwy
Ste 912
Hiram, GA 30141
3104 Creekside Village Dr NW
Ste 504
Kennesaw, GA 30144
Phone (770) 966-0778
1615 Highway 34 E
#A
Newnan, GA 30265
1975 Highway 54 W
Ste 255
Peachtree City, GA 30269
1675 Cumberland Pkwy SE
Ste 407
Smyrna, GA 30080
690 Dallas Hwy
Ste 101
Villa Rica, GA 30180
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Allergy & Immunology Physician | 207K00000X | MD-050257-L | PA | |
| Pediatrics Physician | 208000000X | MD-050257-L | PA | |
| Allergy & Immunology Physician | 207K00000X | 068372 | GA | Yes |
Addresses
Primary practice location
690 Dallas Hwy
Suite 101
Villa Rica, GA 30180-1264
Mailing address
690 Dallas Hwy
Suite 101
Villa Rica, GA 30180-1264
Phone (770) 459-0620
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PENDING | Medicaid | GA |
Other providers in Villa Rica, GA
- Christina Blair
- Shaketha Blankenship
- Jacob Boateng
- Shandon Boddy
- Chelsea Grant Bode
- Bonnie Kristine Boles
- Yolanda Therese Booker
- James Larry Boss
- Johanna Linnea Bozeman
- Carter Dale Brannon
All providers in Villa Rica, GA · Allergy & Immunology Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 11, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.