Healthcare Provider Details

I. General information

NPI: 1336315597
Provider Name (Legal Business Name): DENISE RENEE DRAKE RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 RALPH MCGILL BLVD NE UNIT 1207
ATLANTA GA
30312-1134
US

IV. Provider business mailing address

747 RALPH MC GILL BLVD NE UNIT 1207
ATLANTA GA
30312-1134
US

V. Phone/Fax

Practice location:
  • Phone: 843-271-7465
  • Fax: 955-485-0217
Mailing address:
  • Phone: 843-271-7465
  • Fax: 955-485-0217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License NumberRN108059
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License NumberR200164
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: