Provider Demographics
NPI:1962127738
Name:SOLOMON, RUMONDA MARKETTA
Entity type:Individual
Prefix:
First Name:RUMONDA
Middle Name:MARKETTA
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 BAELL TRACE CT SE
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31788-3029
Mailing Address - Country:US
Mailing Address - Phone:229-921-3465
Mailing Address - Fax:
Practice Address - Street 1:97 BAELL TRACE CT SE
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31788-3029
Practice Address - Country:US
Practice Address - Phone:229-921-3465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056294329347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle