Provider Demographics
NPI:1568655991
Name:TOWNS, MONIQUE FAWN (RT(R))
Entity Type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:FAWN
Last Name:TOWNS
Suffix:
Gender:F
Credentials:RT(R)
Other - Prefix:MISS
Other - First Name:MONIQUE
Other - Middle Name:FAWN
Other - Last Name:CHENEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RT(R)
Mailing Address - Street 1:3703 BRIGHTWATER DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-3011
Mailing Address - Country:US
Mailing Address - Phone:678-838-9717
Mailing Address - Fax:
Practice Address - Street 1:3703 BRIGHTWATER DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-3011
Practice Address - Country:US
Practice Address - Phone:678-838-9717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4011792471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography