Provider Demographics
NPI:1033208475
Name:BANKS, REBECCA (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:210 CLOVER REACH
Mailing Address - Street 2:P.O. BOX 2505
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1657
Mailing Address - Country:US
Mailing Address - Phone:770-487-9604
Mailing Address - Fax:770-631-0540
Practice Address - Street 1:210 CLOVER REACH
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1657
Practice Address - Country:US
Practice Address - Phone:770-487-9604
Practice Address - Fax:770-631-0540
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033271207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00452361GMedicaid
GA16BDTJFMedicare ID - Type Unspecified
GAF04213Medicare UPIN