MEDICARE: REKIYAT SUBAIR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	10041714	OR
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN248628	GA

General Provider Information

NPI Number	:	1619567575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REKIYAT SUBAIR

Provider Business Mailing Address
First Line	:	987 TROPHY CLUB AVE
Second Line	:
City	:	DACULA
State	:	GA
Zip	:	30019-7585
Country	:	US
Telephone Number	:	413-212-0193
Fax Number	:

Provider Business Practice Location Address
First Line	:	8735 DUNWOODY PL STE N
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30350-2995
Country	:	US
Telephone Number	:	413-212-0193
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2021
Last Update Date	:	03/27/2026

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Directions to “ REKIYAT SUBAIR ” Practice Location

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