Provider Demographics
NPI:1477121036
Name:FAIN, REBECCA PODSTATA (ADVANCED PRACTICE NP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:PODSTATA
Last Name:FAIN
Suffix:
Gender:F
Credentials:ADVANCED PRACTICE NP
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Mailing Address - Street 1:980 JOHNSON FERRY RD STE 980
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1609
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:980 JOHNSON FERRY RD STE 980
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1609
Practice Address - Country:US
Practice Address - Phone:404-303-3157
Practice Address - Fax:404-252-4755
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA231274363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health