Provider Demographics
NPI:1619567575
Name:SUBAIR, REKIYAT O
Entity Type:Individual
Prefix:
First Name:REKIYAT
Middle Name:O
Last Name:SUBAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2759 DELK RD SE STE 2547
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8858
Mailing Address - Country:US
Mailing Address - Phone:413-212-0193
Mailing Address - Fax:
Practice Address - Street 1:2759 DELK RD SE STE 2547
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8858
Practice Address - Country:US
Practice Address - Phone:413-212-0193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-24
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN248628163W00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse