Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 035380 | GA |
NPI | 1174567309 |
---|---|
Provider Name | William Carson Boswell |
First Address | Savannah, GA 31404-6268 |
Second Address | Savannah, GA 31404-6200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 04/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000744994B | (05) | GA |
020047820 | RR MEDICARE (01) | GA |
10063463 | AMERIGROUP (01) | GA |
349721 | WELLCARE (01) | GA |
G35380 | (05) | SC |