Individual
JUSTIN MARK BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AA
Contact information
Practice address
2310 N PATTERSON ST, BLDG C, VALDOSTA, GA 31602-2568
(229) 244-6852
(229) 242-2385
Mailing address
2310 N PATTERSON ST, BLDG C, VALDOSTA, GA 31602-2568
(229) 244-6852
(229) 242-2385
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
005470
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005470
GEORGIA LICENSE
GA
Enumeration date
11/12/2008
Last updated
11/12/2008
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