Daphne Dixon Puckett, MLT, MT
Individual provider Active NPI Medical Technologist · Shellman, GA
NPI 1306164496 · NPPES record last updated May 13, 2010
Key facts
- NPI
- 1306164496
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Technologist 246QM0706X
- License
- 80-0530 (GA)
- Practice address
- 3652 Pearl St
Shellman, GA 39886 - Phone
- (229) 679-5446
- NPI assigned
- May 13, 2010
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 80-0530 | GA | MD | Medical Technologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Technologist | 246QM0706X | 80-0530 | GA | Yes |
Addresses
Primary practice location
3652 Pearl St
Shellman, GA 39886
Mailing address
3652 Pearl St
Shellman, GA 39886
Phone (229) 679-5446
Other providers in Shellman, GA
- Jessica Rose Faust
- Tiffany Harrell Garland
- Hospital Authority of Randolph County
- KJH Medical Services
- Georgie Edwards Langford
- Shellman Drug Company
- Shellman Medical LLC
- Shellman Pharmacy
- Shellman Pharmacy
- Southwest Georgia S T E M Charter Inc
All providers in Shellman, GA · Medical Technologist in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 13, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.