Provider Demographics
NPI:1952008856
Name:RATHBURN, DESIREE MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:MARIE
Last Name:RATHBURN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:MARIE
Other - Last Name:MELENDEZ GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2001 ANTIOCH RD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-4622
Mailing Address - Country:US
Mailing Address - Phone:706-272-7600
Mailing Address - Fax:
Practice Address - Street 1:2001 ANTIOCH RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-4622
Practice Address - Country:US
Practice Address - Phone:706-272-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical