Provider Demographics
NPI:1891417788
Name:PETERSON, RACHAEL GABRI (PA-C)
Entity Type:Individual
Prefix:MS
First Name:RACHAEL
Middle Name:GABRI
Last Name:PETERSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:1930 BRANNAN RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-4310
Mailing Address - Country:US
Mailing Address - Phone:678-284-4040
Mailing Address - Fax:
Practice Address - Street 1:1336 HIGHWAY 54 W BLDG 200
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4574
Practice Address - Country:US
Practice Address - Phone:770-460-9777
Practice Address - Fax:770-460-0650
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA11161363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant