Provider Demographics
NPI:1205724556
Name:BOLTON, EMPRESS
Entity type:Individual
Prefix:
First Name:EMPRESS
Middle Name:
Last Name:BOLTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HARTFORD CT
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8266
Mailing Address - Country:US
Mailing Address - Phone:228-861-5600
Mailing Address - Fax:
Practice Address - Street 1:301 HUMBLE AVE STE 490
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-6365
Practice Address - Country:US
Practice Address - Phone:866-264-9450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management