Provider Demographics
NPI:1477832525
Name:RADKE, REBECCA LINTON (NP-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LINTON
Last Name:RADKE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:993 JOHNSON FERRY RD
Mailing Address - Street 2:BLDG C, STE 120
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1620
Mailing Address - Country:US
Mailing Address - Phone:404-790-7860
Mailing Address - Fax:404-851-8673
Practice Address - Street 1:993 JOHNSON FERRY RD
Practice Address - Street 2:BLDG C, STE 120
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1620
Practice Address - Country:US
Practice Address - Phone:404-790-7860
Practice Address - Fax:404-851-8673
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN116771363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003112390EMedicaid
GA20250I6400Medicare PIN