MEDICARE: ACQUINETTA SLATON PHLEBOTOMIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246RP1900X	Phlebotomy Technician	A6R4W3Q9	GA

General Provider Information

NPI Number	:	1922723535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ACQUINETTA SLATON PHLEBOTOMIST

Provider Business Mailing Address
First Line	:	5442 ROCK LAKE DR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-8905
Country	:	US
Telephone Number	:	470-629-8654
Fax Number	:

Provider Business Practice Location Address
First Line	:	5442 ROCK LAKE DR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-8905
Country	:	US
Telephone Number	:	470-629-2483
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2022
Last Update Date	:	10/05/2022

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