Provider Demographics
NPI:1588923254
Name:BOLTON, MEREDITH JENNIFER (MD)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:JENNIFER
Last Name:BOLTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BELINDA
Other - Middle Name:MEREDITH
Other - Last Name:REARDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5780 PEACHTREE DUNWOODY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1513
Mailing Address - Country:US
Mailing Address - Phone:706-548-4272
Mailing Address - Fax:
Practice Address - Street 1:740 PRINCE AVE
Practice Address - Street 2:BUILDING 3
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-5908
Practice Address - Country:US
Practice Address - Phone:706-548-4272
Practice Address - Fax:706-548-9181
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA075955207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3569OtherOPT-OUT
GA300034164AMedicaid