Provider Demographics
NPI:1184671133
Name:BOLTJA, MARGARET C (MD)
Entity type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:C
Last Name:BOLTJA
Suffix:
Gender:
Credentials:MD
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Mailing Address - Street 1:1445 GEORGIA AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-7612
Mailing Address - Country:US
Mailing Address - Phone:478-874-6368
Mailing Address - Fax:877-673-2504
Practice Address - Street 1:1445 GEORGIA AVE STE 3
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7612
Practice Address - Country:US
Practice Address - Phone:478-874-6368
Practice Address - Fax:877-673-2504
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA574342084N0400X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA477650950AMedicaid
GAI55432Medicare UPIN