Provider Demographics
NPI:1538678511
Name:USSERY, RACHEL SMITH (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:SMITH
Last Name:USSERY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:MARIE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:1665 HIGHWAY 34 E STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2404
Mailing Address - Country:US
Mailing Address - Phone:770-252-7557
Mailing Address - Fax:
Practice Address - Street 1:1665 HIGHWAY 34 E STE 100
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2404
Practice Address - Country:US
Practice Address - Phone:770-252-7557
Practice Address - Fax:770-252-7557
Is Sole Proprietor?:No
Enumeration Date:2017-09-22
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN223438363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202192790Medicaid