Provider Demographics
NPI:1467220566
Name:QUALLS, REBEKAH CHRISTINE (RN, HHP)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:CHRISTINE
Last Name:QUALLS
Suffix:
Gender:F
Credentials:RN, HHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3338 COUNTRY CLUB RD STE M3
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-7425
Mailing Address - Country:US
Mailing Address - Phone:229-230-3698
Mailing Address - Fax:
Practice Address - Street 1:3338 COUNTRY CLUB RD STE M3
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-7425
Practice Address - Country:US
Practice Address - Phone:229-230-3698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN308286163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse