Dr Billy Boldon, DO | |
1405 Strong Ave, Greenwood, MS 38930-4035 | |
(662) 459-7030 | |
(662) 459-1104 |
Full Name | Dr Billy Boldon |
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Gender | Male |
Speciality | Pediatrics |
Location | 1405 Strong Ave, Greenwood, Mississippi |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1790754000 | NPI | - | NPPES |
00113949 | Medicaid | MS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | 12903 (Mississippi) | Primary |
Entity Name | State Of Mississippi - University Of Mississippi Medical Center |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1154317527 PECOS PAC ID: 1850293036 Enrollment ID: O20090414000575 |
Entity Name | Greenwood Leflore Hospital |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1669441994 PECOS PAC ID: 8224221619 Enrollment ID: O20101018001016 |
Mailing Address | Practice Location Address |
---|---|
Dr Billy Boldon, DO Po Box 1410, Attn Clinic Administration, Greenwood, MS 38935-1410 Ph: (662) 459-1187 | Dr Billy Boldon, DO 1405 Strong Ave, Greenwood, MS 38930-4035 Ph: (662) 459-7030 |
Dr. Vivian Elizabeth 'lisa' Huddleston, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 1405 Strong Ave, Greenwood, MS 38930 Phone: 662-459-7030 | |
Dr. Claudine Stevens, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 1405 Strong Ave, Greenwood, MS 38930 Phone: 662-459-7030 | |
Mrs. Karlee Kelly, FNP Pediatrics Medicare: Medicare Enrolled Practice Location: 1405 Strong Ave, Greenwood, MS 38930 Phone: 662-459-7030 Fax: 662-459-1104 |