Provider Demographics
NPI:1013532597
Name:RHODES, IVY COOK (PA-C)
Entity type:Individual
Prefix:MRS
First Name:IVY
Middle Name:COOK
Last Name:RHODES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:IVY
Other - Middle Name:ELIZABETH
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:275 COLLIER RD NW STE 470
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1711
Mailing Address - Country:US
Mailing Address - Phone:404-351-1002
Mailing Address - Fax:
Practice Address - Street 1:275 COLLIER RD NW STE 470
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1711
Practice Address - Country:US
Practice Address - Phone:404-351-1002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10503363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty