| Doctor Name: | DAPHNE DIXON PUCKETT |
| NPI Number: | 1306164496 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MLT, MT |
| License Number: | 80-0530 |
| Business Practice Address: | 3652 Pearl St Shellman, GA - 39886 |
| Business Phone Number: | 2296795446 |
| Business Fax Number: | |
| Mailing Address: | 3652 Pearl St, SHELLMAN |
| State: | GA |
| Postal Code: | 39886 |
| Phone Number: | 2296795446 |
| Fax Number: | |
| NPI Enumeration Date: | 05/13/2010 |
| NPI Last Update Date: | 05/13/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 246QM0706X |
| License Number: | 80-0530 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Spec/Tech, Pathology |
| Taxonomy Specialization: | Medical Technologist |
| Taxonomy Definition: | |