Healthcare Provider Details

I. General information

NPI: 1922718204
Provider Name (Legal Business Name): ANGERENTHEA COOKIE STRIPLING CERTIFIED PHLEBOTOMY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

866 RIDGE AVE NW
ATLANTA GA
30318-8306
US

IV. Provider business mailing address

866 RIDGE AVE NW
ATLANTA GA
30318-8306
US

V. Phone/Fax

Practice location:
  • Phone: 404-759-4325
  • Fax:
Mailing address:
  • Phone: 404-759-4325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number920326837
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: