Provider Demographics
NPI:1659001949
Name:ELVIS, RACHEL COOK (DMD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:COOK
Last Name:ELVIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 BARRETT LN
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-3453
Mailing Address - Country:US
Mailing Address - Phone:843-373-9009
Mailing Address - Fax:
Practice Address - Street 1:143 TRAFALGAR ST SW
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-3760
Practice Address - Country:US
Practice Address - Phone:803-641-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.102121223G0001X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223G0001XDental ProvidersDentistGeneral Practice