Healthcare Provider Details

I. General information

NPI: 1366810590
Provider Name (Legal Business Name): REBECCA CAWTHON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE OFC F711
ATLANTA GA
30322-8407
US

IV. Provider business mailing address

1821 CLIFTON RD NE STE 1017
ATLANTA GA
30329-4021
US

V. Phone/Fax

Practice location:
  • Phone: 404-416-0722
  • Fax:
Mailing address:
  • Phone: 404-416-0722
  • Fax: 404-728-6925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberRN279567
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5007958
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN279567
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: