Provider Demographics
NPI:1477121036
Name:FAIN, REBECCA PODSTATA (ADVANCED PRACTICE NP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:PODSTATA
Last Name:FAIN
Suffix:
Gender:F
Credentials:ADVANCED PRACTICE NP
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Mailing Address - Street 1:2701 N DECATUR RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5918
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2701 N DECATUR RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5918
Practice Address - Country:US
Practice Address - Phone:404-501-1624
Practice Address - Fax:404-252-4755
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2024-06-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA231274363LW0102X
GARN231274207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health