Provider Demographics
NPI:1780352344
Name:ECKELBARGER, RACHEL (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:ECKELBARGER
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 BRANDYWINE CIR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-2004
Mailing Address - Country:US
Mailing Address - Phone:317-674-2574
Mailing Address - Fax:
Practice Address - Street 1:900 TOWNE LAKE PKWY STE 320
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-1604
Practice Address - Country:US
Practice Address - Phone:770-517-6636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN249904163W00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse