Provider Demographics
NPI:1659542165
Name:BADACH, REBECCA J (PA)
Entity Type:Individual
Prefix:MISS
First Name:REBECCA
Middle Name:J
Last Name:BADACH
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Gender:F
Credentials:PA
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Mailing Address - Street 1:55 CARLTON ST
Mailing Address - Street 2:UGA, UNIVERISTY HEALTH CENTER
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30602-1755
Mailing Address - Country:US
Mailing Address - Phone:706-542-8636
Mailing Address - Fax:706-542-0214
Practice Address - Street 1:55 CARLTON ST
Practice Address - Street 2:UGA, UNIVERISTY HEALTH CENTER
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30602-1755
Practice Address - Country:US
Practice Address - Phone:706-542-8636
Practice Address - Fax:706-542-0214
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2009-10-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
2255A2300X
GA004713363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30332876Medicaid
NH30332876Medicaid