Provider Demographics
NPI:1275777971
Name:GLASS, RACHEL BURKE (DO)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:BURKE
Last Name:GLASS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:DAMARIS
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1112 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:GA
Mailing Address - Zip Code:31510-1814
Mailing Address - Country:US
Mailing Address - Phone:912-632-8244
Mailing Address - Fax:912-632-7041
Practice Address - Street 1:1112 W 12TH ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:GA
Practice Address - Zip Code:31510-1814
Practice Address - Country:US
Practice Address - Phone:912-632-8244
Practice Address - Fax:912-632-7041
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-24
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA066997208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics