Provider Demographics
NPI:1710765284
Name:HUCKABY, RACHEL JORDAN (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:JORDAN
Last Name:HUCKABY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:JORDAN
Other - Last Name:CAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:5416 N PEACHTREE RD
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-3134
Mailing Address - Country:US
Mailing Address - Phone:770-846-6233
Mailing Address - Fax:
Practice Address - Street 1:2292 PEACHTREE RD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1147
Practice Address - Country:US
Practice Address - Phone:404-996-0120
Practice Address - Fax:404-351-6762
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN258590363LF0000X
GA258590261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care