Healthcare Provider Details

I. General information

NPI: 1306171236
Provider Name (Legal Business Name): RACHEL ELIZABETH RACKARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2009
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40870 AL HIGHWAY 69 STE A
MOUNDVILLE AL
35474-4367
US

IV. Provider business mailing address

40870 AL HIGHWAY 69 STE A
MOUNDVILLE AL
35474-4367
US

V. Phone/Fax

Practice location:
  • Phone: 205-371-4444
  • Fax: 205-371-8745
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH9709
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME147030
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.37318
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: