Healthcare Provider Details

I. General information

NPI: 1528987583
Provider Name (Legal Business Name): RACHEL HALVERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 SCOUT DR
ACWORTH GA
30102-1757
US

IV. Provider business mailing address

725 SCOUT DR
ACWORTH GA
30102-1757
US

V. Phone/Fax

Practice location:
  • Phone: 678-777-3129
  • Fax:
Mailing address:
  • Phone: 678-777-3129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN279172
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: