| Doctor Name: | FERNANDA BODDEN |
| NPI Number: | 1629401971 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 15030 |
| Business Practice Address: | 107 Chief Ct Rockmart, GA - 301538017 |
| Business Phone Number: | 9084991339 |
| Business Fax Number: | |
| Mailing Address: | 107 Chief Ct, ROCKMART |
| State: | GA |
| Postal Code: | 301538017 |
| Phone Number: | 9084991339 |
| Fax Number: | |
| NPI Enumeration Date: | 08/09/2013 |
| NPI Last Update Date: | 08/09/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 246RP1900X |
| License Number: | 15030 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Technician, Pathology |
| Taxonomy Specialization: | Phlebotomy |
| Taxonomy Definition: | |