Booth, Justin Mark

Booth, Justin Mark is an individual health care provider with primary practice located at 2310 N Patterson St Bldg C, Valdosta GA 31602-2568. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Anesthesiologist Assistant, which is considered as his primary health care specialty. Booth, Justin Mark can be contacted via phone (229) 244-6852.

Contact Information

Primary practice address
2310 N Patterson St Bldg C Valdosta GA 31602-2568
Phone: (229) 244-6852
Fax: (229) 242-2385
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Anesthesiologist Assistant 367H00000X 005470 Georgia

Profile Details

NPI number 1306090675
LBN Legal business name Booth, Justin Mark
Credentials Associate of Arts (AA)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 12th, 2008
Last updated Nov 12th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306090675 NPPES
Georgia Other 005470 GEORGIA LICENSE

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