Provider Demographics
NPI:1912886391
Name:BOONE, ELIZABETH ANN (CSTFA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:BOONE
Suffix:
Gender:F
Credentials:CSTFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 ORCHARD CIR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30656-7939
Mailing Address - Country:US
Mailing Address - Phone:678-863-2983
Mailing Address - Fax:
Practice Address - Street 1:1199 PRINCE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2797
Practice Address - Country:US
Practice Address - Phone:706-475-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant