Provider Demographics
NPI:1134714702
Name:BOGGS, PAULETTE J
Entity type:Individual
Prefix:
First Name:PAULETTE
Middle Name:J
Last Name:BOGGS
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 1:2745 HAPEVILLE RD SW APT 401
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30354-2076
Mailing Address - Country:US
Mailing Address - Phone:678-949-3367
Mailing Address - Fax:
Practice Address - Street 1:4756 GLENWOOD RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-1634
Practice Address - Country:US
Practice Address - Phone:678-949-3367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider