Provider Demographics
NPI:1083064539
Name:SWEENEY, RACHAEL L (NP-BC)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:L
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 MUSTANG TRL
Mailing Address - Street 2:
Mailing Address - City:WAVERLY HALL
Mailing Address - State:GA
Mailing Address - Zip Code:31831-2399
Mailing Address - Country:US
Mailing Address - Phone:801-842-3776
Mailing Address - Fax:
Practice Address - Street 1:801 W GORDON ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3426
Practice Address - Country:US
Practice Address - Phone:706-647-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN199221163WF0300X, 363LF0000X, 363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WF0300XNursing Service ProvidersRegistered NurseFlight
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care