Provider Demographics
NPI:1982764437
Name:SMITH, RACHEL STALLINGS (FNP C)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:STALLINGS
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:101 REGENCY PARK DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253
Mailing Address - Country:US
Mailing Address - Phone:770-957-3935
Mailing Address - Fax:770-954-0573
Practice Address - Street 1:545 VENTURE CT
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:GA
Practice Address - Zip Code:31064-7788
Practice Address - Country:US
Practice Address - Phone:706-468-7002
Practice Address - Fax:877-870-3481
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF0605178363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
14247677OtherCAQH
GA003214562AMedicaid