Individual
KIANNA TYMORIA BOONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
608 S LEE ST, FITZGERALD, GA 31750-3217
(229) 472-2246
Mailing address
608 S LEE ST, FITZGERALD, GA 31750-3217
(229) 472-2246
Taxonomy
Speciality
Code
Description
License number
State
246RP1900X
Phlebotomy Technician
Primary
318-10178
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20070770
ARTICLE OF ORGANIZATION
GA
Enumeration date
06/04/2020
Last updated
06/04/2020
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