Provider Demographics
NPI:1568130672
Name:THOMAS, RAQUEL AMELIA (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:AMELIA
Last Name:THOMAS
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 1:3746 BERKELEY XING
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8086
Mailing Address - Country:US
Mailing Address - Phone:470-591-0314
Mailing Address - Fax:
Practice Address - Street 1:3746 BERKELEY XING
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8086
Practice Address - Country:US
Practice Address - Phone:470-591-0314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2021-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN264712363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily