DAPHNE DIXON PUCKETT (NPI# 1306164496) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306164496 |
| Entity Type | Individual |
| Full Name | DAPHNE DIXON PUCKETT |
| Credential | MLT, MT |
| Practice Address |
3652 Pearl St Shellman GA 39886 |
| Practice Telephone | 2296795446 |
| Mailing Telephone | 2296795446 |
| Enumeration Date | 2010-05-13 |
| Last Update Date | 2010-05-13 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 246QM0706X |
Spec/Tech, Pathology Specialization: Medical Technologist |
80-0530 | GA | Technologists, Technicians & Other Technical Service Providers |
| Street Address |
3652 PEARL ST |
| City | SHELLMAN |
| State | GA |
| Zip Code | 39886 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992279855 | Shellman Pharmacy | Pharmacy | 75 West Railroad St., Shellman, GA 39886 | 2019-01-14 |
| 1134136047 | Shellman Drug Company | Pharmacy | 210 W Railroad St, Shellman, GA 39886 | 2006-08-02 |
| 1750340584 | Georgie Edwards Langford | Pharmacist | 210 West Railroad Street, Shellman, GA 39886 | 2006-03-21 |
| 1174074710 | Southwest Georgia S T E M Charter Inc | Local Education Agency (LEA) | 185 Pecan St, Shellman, GA 39886-2548 | 2016-10-19 |
| 1750311221 | Bryan S Green | Physician Assistant | 67 W Railroad St, Shellman, GA 39886-3100 | 2006-07-03 |
| 1912481482 | Kjh Medical Services | Family Medicine | 67 W Railroad St, Shellman, GA 39886-3100 | 2018-09-20 |
| 1104356302 | Betsy Diaz | Nurse Practitioner | 67 W Railroad St, Shellman, GA 39886-3100 | 2017-06-20 |
| 1629041421 | Hospital Authority of Randolph County | Clinic/Center | 206 West Railroad Street, Shellman, GA 39886-5003 | 2006-02-10 |
| Taxonomy Code | 246QM0706X |
| Grouping | Technologists, Technicians & Other Technical Service Providers |
| Classification | Spec/Tech, Pathology |
| Specialization | Medical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083171045 | Arianna Curtis Bartleson | Spec/Tech, Pathology | 1014 Durban Dr, Grovetown, GA 30813-2243 | 2019-02-26 |
| 1093010548 | Beverley Hyacinth Chin | Spec/Tech, Pathology | 4435 Boatmans Cv, Stone Mountain, GA 30083-2483 | 2011-01-13 |
| 1841453701 | Susan D Bulla | Spec/Tech, Pathology | 86 South Cobb Drive, Mail Zone 0454, Marietta, GA 30066-0454 | 2008-07-09 |
| 1619916186 | Jonathan Blackmon | Spec/Tech, Pathology | 603 Wild Grape Dr, Saint Marys, GA 31558-3619 | 2006-06-06 |
| 1518513233 | Mukhtar O Awad | Spec/Tech, Pathology | 1670 Clairmont Rd, Decatur, GA 30033-4004 | 2019-08-19 |
| 1073630059 | Cherron Lakisha Blakely | Spec/Tech, Pathology | 1826 Veterans Blvd, Bldg 3a, Pathology and Laboratory Medicine, Dublin, GA 31021-3620 | 2007-03-23 |
Please comment or provide details below to improve the information on DAPHNE DIXON PUCKETT.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.