| NPI | 1194133884 |
|---|---|
| Doing Business As | BOULEVARD FAMILY PRACTICE |
| Entity Type | Organization |
| Authorized Contact | THOMAS WEINER Physician 706-850-6134 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2014-07-26 |
| Last Update Date | 2020-07-28 |