Provider Demographics
NPI:1326146549
Name:DRAKE, DEBORAH MARIE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:MARIE
Last Name:DRAKE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:MARIE
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:479 RISING STAR RD
Mailing Address - Street 2:
Mailing Address - City:BROOKS
Mailing Address - State:GA
Mailing Address - Zip Code:30205-1525
Mailing Address - Country:US
Mailing Address - Phone:678-572-7535
Mailing Address - Fax:
Practice Address - Street 1:303 PARKWAY DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1212
Practice Address - Country:US
Practice Address - Phone:678-572-7535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9170541367500000X
GARN219462367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307348300Medicaid
FLU4565AMedicare PIN