JUSTIN MARK BOOTH (NPI# 1306090675) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306090675 |
| Entity Type | Individual |
| Full Name | JUSTIN MARK BOOTH |
| Credential | AA |
| Practice Address |
2310 N Patterson St Bldg C Valdosta GA 31602-2568 |
| Practice Telephone | 2292446852 |
| Practice Fax Number | 2292422385 |
| Mailing Telephone | 2292446852 |
| Mailing Fax Number | 2292422385 |
| Enumeration Date | 2008-11-12 |
| Last Update Date | 2008-11-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 367H00000X | Anesthesiologist Assistant | 005470 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | GEORGIA LICENSE | 005470 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376846576 | Justin Booth | Pharmacist | Us Route 119 Holden Road, Mount Gay, WV 25637-1264 | 2010-12-09 |
| 1447570916 | Justin Henry Booth | Plastic Surgery | 300 Beardsley Ln Ste C101, Austin, TX 78746-4949 | 2010-06-08 |
| Street Address |
2310 N PATTERSON ST BLDG C |
| City | VALDOSTA |
| State | GA |
| Zip Code | 31602-2568 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215938501 | Raymond Derry Crosby | Orthopaedic Surgery | 2310 N Patterson St, Bldg D, Valdosta, GA 31602-2568 | 2005-08-09 |
| 1770951253 | Dustin Goff | Nurse Anesthetist, Certified Registered | 2310 N Patterson St, Suite C, Valdosta, GA 31602-2568 | 2015-09-14 |
| 1891095840 | Karen Alene Bowser | Nurse Practitioner | 2310 N Patterson St, Suite G, Valdosta, GA 31602-2568 | 2010-10-25 |
| 1104134683 | Stephany Ann Norris | Counselor | 2310 N Patterson St, Suite G, Valdosta, GA 31602-2568 | 2010-09-18 |
| 1023275757 | Kelly Delayne Jones | Social Worker | 2310 N Patterson St, Suite G, Valdosta, GA 31602-2568 | 2008-05-20 |
| 1134316920 | South Georgia Orthopedics, P.C. | Clinic/Center | 2310 N Patterson St, Bld. D, Valdosta, GA 31602-2568 | 2007-09-26 |
| 1053527945 | Leah Carol Mcmillan | Marriage & Family Therapist | 2310 N Patterson St, Suite G, Valdosta, GA 31602-2568 | 2007-05-15 |
| 1316020043 | Southern Eye Center, PC | Optometrist | 2310 N Patterson St, Suite B, Valdosta, GA 31602-2568 | 2006-10-24 |
| 1467556944 | Lance Jason Haluka | Optometrist | 2310 N Patterson St, Suite B, Valdosta, GA 31602-2568 | 2006-09-12 |
| 1205947496 | Mark Joseph Eanes | Ophthalmology | 2310 N Patterson St, Suite B, Valdosta, GA 31602-2568 | 2006-08-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477198117 | Amber Michele Baugh | Behavior Technician | 2236 Bemiss Road, Valdosta, GA 31602 | 2019-11-15 |
| 1528611365 | Nishaben T. Patel | Nurse Practitioner | 3120 North Oak Street Extension, Suite B, Valdosta, GA 31602 | 2019-07-22 |
| 1427615871 | Blair Elizabeth Tomlinson | Nurse Practitioner | 2124 Lakeshore Drive, Valdosta, GA 31602 | 2019-05-21 |
| 1346704152 | Mildred Itaska Borowski | Counselor | 3790 North Highway 41, Suite A, Valdosta, GA 31602 | 2019-01-25 |
| 1962991703 | Southern Healthcare Alliance, LLC | Physical Medicine & Rehabilitation | 101-f W. Northside Drive, Valdosta, GA 31602 | 2018-05-08 |
| 1336636646 | Kaitlyn Thrift | Behavioral Analyst | 2225 Bemiss Road Suite D, Valdosta, GA 31602 | 2018-04-23 |
| 1407379845 | Lindsey Marie Richardson | Dentist | 103 W. Cranford Ave, Valdosta, GA 31602 | 2017-07-18 |
| 1962922427 | Taylor Nicole Fiveash | Nurse Practitioner | 101 W Northisde Dr, Bldg G, Valdosta, GA 31602 | 2017-06-26 |
| 1720520646 | Southern Sleepers Anesthesia LLC | Nurse Anesthetist, Certified Registered | 4120-b N. Valdosta Road, Valdosta, GA 31602 | 2016-11-09 |
| 1134670557 | Cataract and Laser Surgery Center of South Georgia, P.C. | Clinic/Center | 4120-b N. Valdosta Rd., Valdosta, GA 31602 | 2016-10-20 |
| Find all providers in zip 31602 | ||||
| Taxonomy Code | 367H00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Anesthesiologist Assistant |
| An individual certified by the state to perform anesthesia services under the direct supervision of an anesthesiologist. Anesthesiologist Assistants are required to have a bachelor's degree with a premed curriculum prior to entering a two-year anesthesiology assistant program, which is focused upon the delivery and maintenance of anesthesia care as well as advanced patient monitoring techniques. An Anesthesiologist Assistant must work as a member of the anesthesia care team under the direction of a qualified Anesthesiologist. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669878971 | Erica Mcclure | Anesthesiologist Assistant | 4280 N Valdosta Rd, Valdosta, GA 31602-6814 | 2014-11-13 |
| 1962753137 | Bonnie Smith Skinner | Anesthesiologist Assistant | 2501 N. Patterson Street, Valdosta, GA 31602 | 2012-09-27 |
| 1730447467 | Dana Marie Burgio Adams | Anesthesiologist Assistant | 4280 N Valdosta Rd, Valdosta, GA 31602-6814 | 2012-05-01 |
| 1932416252 | Emily R Copeland | Anesthesiologist Assistant | 4280 N Valdosta Rd, Dept of Anesthesia, Valdosta, GA 31602-6814 | 2010-09-08 |
| 1497080659 | Jason Michael Geddings | Anesthesiologist Assistant | 2310 N Patterson St Bldg C, Valdosta, GA 31602-2500 | 2009-10-06 |
| 1164673224 | Andrew Blake Gay | Anesthesiologist Assistant | 2501 N Patterson St, Sgmc, Valdosta, GA 31602-1735 | 2008-10-08 |
| 1053453449 | Allison Peake | Anesthesiologist Assistant | 4280 N Valdosta Rd, Dept of Anesthesia, Valdosta, GA 31602-6814 | 2007-02-13 |
| 1891893806 | Anthony Marzano | Anesthesiologist Assistant | 2501 N Patterson St, Sgmc, Valdosta, GA 31602-1735 | 2006-09-21 |
| 1659479665 | Thomas Franklin Woods Jr. | Anesthesiologist Assistant | 2501 N Patterson St, Sgmc, Valdosta, GA 31602-1735 | 2006-09-21 |
| 1205934205 | Bonnie Kay Johnson | Anesthesiologist Assistant | 2501 N Patterson St, Sgmc, Valdosta, GA 31602-1735 | 2006-09-21 |
| Find all providers in VALDOSTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.