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Individual

DAPHNE DIXON PUCKETT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MLT, MT

Contact information

Practice address
3652 PEARL ST, SHELLMAN, GA 39886
(229) 679-5446
Mailing address
3652 PEARL ST, SHELLMAN, GA 39886
(229) 679-5446

Taxonomy

Speciality
Code
Description
License number
State
246QM0706X
Medical Technologist
Primary
80-0530
GA

Other

Enumeration date
05/13/2010
Last updated
05/13/2010
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