Provider Demographics
NPI: | 1619525045 |
---|---|
Name: | SHARP, RACHEL EMILY (PA-C, RD) |
Entity Type: | Individual |
Prefix: | |
First Name: | RACHEL |
Middle Name: | EMILY |
Last Name: | SHARP |
Suffix: | |
Gender: | F |
Credentials: | PA-C, RD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1273 WITHAM DR |
Mailing Address - Street 2: | |
Mailing Address - City: | DUNWOODY |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30338-3334 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 404-694-4214 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1364 CLIFTON RD NE |
Practice Address - Street 2: | |
Practice Address - City: | ATLANTA |
Practice Address - State: | GA |
Practice Address - Zip Code: | 30322-1064 |
Practice Address - Country: | US |
Practice Address - Phone: | 404-712-2000 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2019-08-28 |
Last Update Date: | 2022-03-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
390200000X | ||
GA | 133V00000X | |
GA | 10918 | 363AM0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Single Specialty |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program | ||
No | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered |