Provider Demographics
NPI:1699591115
Name:PAULK, APRIL (CPT, CNA)
Entity type:Individual
Prefix:MS
First Name:APRIL
Middle Name:
Last Name:PAULK
Suffix:
Gender:F
Credentials:CPT, CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 SUMMER LEIGH DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5895
Mailing Address - Country:US
Mailing Address - Phone:404-452-2817
Mailing Address - Fax:
Practice Address - Street 1:804 COMMERCE BLVD
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-7198
Practice Address - Country:US
Practice Address - Phone:404-452-2817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-30
Last Update Date:2024-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0000018284376K00000X
GA20-1310Y09246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No376K00000XNursing Service Related ProvidersNurse's Aide