Individual
TIMANTHA D BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
172 MJ TAYLOR RD, ADEL, GA 31620-3497
(229) 896-3424
(229) 896-3838
Mailing address
907 18TH ST E STE 400, TIFTON, GA 31794-3684
(229) 353-3422
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
005888
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005888
005888
GA
Enumeration date
08/20/2010
Last updated
03/30/2021
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