Healthcare Provider Details

I. General information

NPI: 1033083613
Provider Name (Legal Business Name): JAVIER S RINCON SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 WESTCHESTER DR APT 21
ATHENS GA
30606-2050
US

IV. Provider business mailing address

205 WESTCHESTER DR APT 21
ATHENS GA
30606-2050
US

V. Phone/Fax

Practice location:
  • Phone: 706-540-7848
  • Fax: 706-540-6147
Mailing address:
  • Phone: 706-540-7848
  • Fax: 706-540-6147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number20240917142141
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number20240917142142
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: