Healthcare Provider Details

I. General information

NPI: 1255890703
Provider Name (Legal Business Name): RACHEL BRANTON LARSH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL ELIZABETH BRANTON NP

II. Dates (important events)

Enumeration Date: 03/14/2019
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 PEACHTREE RD NW
ATLANTA GA
30309-1281
US

IV. Provider business mailing address

PO BOX 102847
ATLANTA GA
30368-2847
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-3580
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN216220
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN216220
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN216220
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: