Provider Demographics
NPI:1790333128
Name:ANTON, RACHEL KASIN (PA-C)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:KASIN
Last Name:ANTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KASIN
Other - Middle Name:
Other - Last Name:ANTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:5830 BOND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-0308
Mailing Address - Country:US
Mailing Address - Phone:770-205-5518
Mailing Address - Fax:770-205-5519
Practice Address - Street 1:5830 BOND ST STE 200
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-0308
Practice Address - Country:US
Practice Address - Phone:770-205-5518
Practice Address - Fax:770-205-5519
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10879363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty