MEDICARE: ASANTI BOONE

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	106S00000X	Behavior Technician	RBT-21-159267	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00000000000	OTHER		N/A

General Provider Information

NPI Number	:	1609464643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASANTI BOONE

Provider Business Mailing Address
First Line	:	5461 HILLANDALE DR STE 100
Second Line	:
City	:	LITHONIA
State	:	GA
Zip	:	30058-4842
Country	:	US
Telephone Number	:	612-402-9763
Fax Number	:

Provider Business Practice Location Address
First Line	:	5461 HILLANDALE DR
Second Line	:
City	:	LITHONIA
State	:	GA
Zip	:	30058-4841
Country	:	US
Telephone Number	:	470-361-2976
Fax Number	:

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

Provider Enumeration Date	:	01/05/2021
Last Update Date	:	05/10/2023

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Directions to “ ASANTI BOONE ” Practice Location

Language	Start Address	Practice Location

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