Healthcare Provider Details

I. General information

NPI: 1194051698
Provider Name (Legal Business Name): KARENE GAILE BOONE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 HIGHWAY 81 STE 100
LOGANVILLE GA
30052-9138
US

IV. Provider business mailing address

3765 SPRING PLACE CT
LOGANVILLE GA
30052-5048
US

V. Phone/Fax

Practice location:
  • Phone: 678-376-9309
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRN153196
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN153196
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: