Provider Demographics
NPI:1982143129
Name:ANNTIONEEK BOSTON
Entity Type:Organization
Organization Name:ANNTIONEEK BOSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HAIR LOSS SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNTIONEEK
Authorized Official - Middle Name:MARSHELLE
Authorized Official - Last Name:BOSTON
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED
Authorized Official - Phone:678-744-3440
Mailing Address - Street 1:PO BOX 733
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:GA
Mailing Address - Zip Code:30268-0733
Mailing Address - Country:US
Mailing Address - Phone:678-744-3440
Mailing Address - Fax:
Practice Address - Street 1:870 CRESTMARK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-2665
Practice Address - Country:US
Practice Address - Phone:678-744-3440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1744P3200XOtherMEDICAL INSURANCE COMPANIES