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General NPI Number Information
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NPI Number | 1194288415
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Entity Type | Individual
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Provider Name | CORTNEY RAYE BOOTH DO
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Gender | Female
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Dates
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Enumeration Date | 04/12/2019
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Last Update Date | 08/10/2023
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Provider Practice Location Address
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Address Line | 620 SUMMIT CROSSING PL STE 108A
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City | GASTONIA
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State | NC
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Zip | 28054-2189
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Country | US
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Telephone | 704-671-5313
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 744786
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City | ATLANTA
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State | GA
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Zip | 30374-4786
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 90015
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 00646
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License Number State | NC
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