Healthcare Provider Details

I. General information

NPI: 1184736290
Provider Name (Legal Business Name): RACHEL MARIE JOHNSON KORNRICH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 N SHALLOWFORD RD
ATLANTA GA
30338-6476
US

IV. Provider business mailing address

4500 N SHALLOWFORD RD
ATLANTA GA
30338-6476
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-6920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number069059
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number069059
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: