Healthcare Provider Details

I. General information

NPI: 1063696482
Provider Name (Legal Business Name): RANA SIBAI-DRAKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 COURTENAY DRIVE
ATLANTA GA
30306
US

IV. Provider business mailing address

690 COURTENAY DRIVE
ATLANTA GA
30306
US

V. Phone/Fax

Practice location:
  • Phone: 404-875-4551
  • Fax: 404-875-0837
Mailing address:
  • Phone: 404-875-4551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number067994
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number067994
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: