Provider Demographics
NPI:1881187581
Name:MIDDLEBROOKS, REBEKAH (CNA)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:MIDDLEBROOKS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 SPRING CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-1696
Mailing Address - Country:US
Mailing Address - Phone:770-284-1861
Mailing Address - Fax:720-368-8755
Practice Address - Street 1:832 SPRING CREEK WAY
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-1696
Practice Address - Country:US
Practice Address - Phone:770-284-1861
Practice Address - Fax:720-368-8775
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048-R-1661251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA473360319OtherINSURANCE COMPANIES