Provider Demographics
NPI:1740214212
Name:BOONE, HERBERTTA PEARSON (MD)
Entity Type:Individual
Prefix:
First Name:HERBERTTA
Middle Name:PEARSON
Last Name:BOONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16273
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31040-6273
Mailing Address - Country:US
Mailing Address - Phone:478-290-0353
Mailing Address - Fax:
Practice Address - Street 1:102 WHITE OAK CIR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-3701
Practice Address - Country:US
Practice Address - Phone:478-290-0353
Practice Address - Fax:866-228-6529
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA38329207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF55410Medicare UPIN