Provider Demographics
NPI:1972545119
Name:VELEZ, RACHEL G (DO)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:G
Last Name:VELEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 W SCREVEN ST
Mailing Address - Street 2:PO BOX 845
Mailing Address - City:QUITMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31643-1922
Mailing Address - Country:US
Mailing Address - Phone:229-263-8888
Mailing Address - Fax:229-263-6528
Practice Address - Street 1:606 W SCREVEN ST
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:GA
Practice Address - Zip Code:31643-1922
Practice Address - Country:US
Practice Address - Phone:229-263-8888
Practice Address - Fax:229-263-6528
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039500207Q00000X
GARN154383363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00639922IMedicaid
GAF95665Medicare UPIN
GA08BBVMFMedicare ID - Type Unspecified