Provider Demographics
NPI:1982874939
Name:BOOTH, MARY BARRON (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BARRON
Last Name:BOOTH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:BARRON
Other - Last Name:BOOTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:RENTZ
Mailing Address - State:GA
Mailing Address - Zip Code:31075-0458
Mailing Address - Country:US
Mailing Address - Phone:770-722-9595
Mailing Address - Fax:478-984-5786
Practice Address - Street 1:1640 POWERS FERRY RD
Practice Address - Street 2:BUILDING 15, SUITE 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5491
Practice Address - Country:US
Practice Address - Phone:770-722-9595
Practice Address - Fax:770-446-9532
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT001398174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist