Provider Demographics
NPI:1568507622
Name:BOONE, RENEE N (MT-BC)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:N
Last Name:BOONE
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1098 N JAMESTOWN RD
Mailing Address - Street 2:APT. H
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-7113
Mailing Address - Country:US
Mailing Address - Phone:405-600-4458
Mailing Address - Fax:
Practice Address - Street 1:1098 N JAMESTOWN RD
Practice Address - Street 2:APT. H
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-7113
Practice Address - Country:US
Practice Address - Phone:405-600-4458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist