Healthcare Provider Details

I. General information

NPI: 1275777971
Provider Name (Legal Business Name): RACHEL BURKE GLASS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RACHEL DAMARIS BURKE D.O.

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 W 12TH ST
ALMA GA
31510-1814
US

IV. Provider business mailing address

1112 W 12TH ST
ALMA GA
31510-1814
US

V. Phone/Fax

Practice location:
  • Phone: 912-632-8244
  • Fax: 912-632-7041
Mailing address:
  • Phone: 912-632-8244
  • Fax: 912-632-7041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number066997
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: