NPI 1982739041

James Brian Boulware, MAATCOTCLAT

Practitioner Athletic Trainer Lilburn, GA

Practice location

Address: 475 Bruce Way SW, Lilburn, GA 30047-3025
Phone: (678) 764-6364
Mailing address: 1014 Sycamore Dr Suite B, Decatur, GA 30030-1644

Registered specialties

Athletic Trainer Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 2255A2300X Licence AT001328 (GA)

Other Specialist/Technologist providers in Georgia →

Registry record

NPI: 1982739041
Entity type: Individual
Sex (as registered): Male
NPI issued: 22 Feb 2007
Record last updated: 25 May 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.