Healthcare Provider Details

I. General information

NPI: 1265012090
Provider Name (Legal Business Name): RACHAEL M DENT AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 06/14/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 2ND AVE S # NB1002
BIRMINGHAM AL
35294-1210
US

IV. Provider business mailing address

2720 IVY MILL DR
BUFORD GA
30519-6702
US

V. Phone/Fax

Practice location:
  • Phone: 205-975-7529
  • Fax:
Mailing address:
  • Phone: 404-906-4284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN209337
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN209337
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: