Provider Demographics
NPI:1609866482
Name:BURT, RACHEL (CNP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:BURT
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 BRIARCLIFF PL NE
Mailing Address - Street 2:#5
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-3908
Mailing Address - Country:US
Mailing Address - Phone:404-625-8492
Mailing Address - Fax:
Practice Address - Street 1:6063 PEACHTREE PKWY
Practice Address - Street 2:SUITE 203-A
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-3303
Practice Address - Country:US
Practice Address - Phone:770-840-4049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN165332 NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health