MEDICARE: EBENI PASSMORE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246RP1900X	Phlebotomy Technician		GA

General Provider Information

NPI Number	:	1194575134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EBENI PASSMORE

Provider Business Mailing Address
First Line	:	1770 OLD SPRING HOUSE LN # 116A
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30338-6213
Country	:	US
Telephone Number	:	404-416-3817
Fax Number	:

Provider Business Practice Location Address
First Line	:	1770 OLD SPRING HOUSE LN # 116A
Second Line	:
City	:	DUNWOODY
State	:	GA
Zip	:	30338-6213
Country	:	US
Telephone Number	:	404-416-3817
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2024
Last Update Date	:	03/25/2024

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Directions to “ EBENI PASSMORE ” Practice Location

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