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General NPI Number Information
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NPI Number | 1982143129
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Entity Type | Organization
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Legal Business Name | ANNTIONEEK BOSTON
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Dates
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Enumeration Date | 02/21/2017
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Last Update Date | 02/21/2017
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Provider Practice Location Address
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Address Line | 870 CRESTMARK DR SUITE 200
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City | LITHIA SPRINGS
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State | GA
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Zip | 30122-2665
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Country | US
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Telephone | 678-744-3440
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 733
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City | PALMETTO
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State | GA
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Zip | 30268-0733
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Country | US
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Telephone | 678-744-3440
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Fax |
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Authorized Official
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Title or Position | HAIR LOSS SPECIALIST
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Name | MS. ANNTIONEEK MARSHELLE BOSTON
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Credential | CERTIFIED
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Telephone | 678-744-3440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State | GA
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