Provider Demographics
NPI:1437157112
Name:ATKINSON, REBECCA M (OD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 GREENLEAF CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-1287
Mailing Address - Country:US
Mailing Address - Phone:270-307-6762
Mailing Address - Fax:
Practice Address - Street 1:6600 VAN AALST BLVD
Practice Address - Street 2:
Practice Address - City:FORT BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905-2102
Practice Address - Country:US
Practice Address - Phone:762-408-3507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1307DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77001279Medicaid
KY0322817Medicare ID - Type Unspecified
KY0224921Medicare ID - Type Unspecified
KY77001279Medicaid
KY0959006Medicare ID - Type Unspecified
KY9295520Medicare ID - Type Unspecified
KYV01054Medicare UPIN