Healthcare Provider Details

I. General information

NPI: 1003388273
Provider Name (Legal Business Name): JANET BOONE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2018
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 W MLK JR BLVD
MC RAE HELENA GA
31055-4150
US

IV. Provider business mailing address

820 2ND AVE
EASTMAN GA
31023-6112
US

V. Phone/Fax

Practice location:
  • Phone: 229-868-2106
  • Fax: 229-868-2107
Mailing address:
  • Phone: 229-868-2106
  • Fax: 229-868-2107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF10181653
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: