Healthcare Provider Details

I. General information

NPI: 1619567575
Provider Name (Legal Business Name): REKIYAT SUBAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2021
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8735 DUNWOODY PL STE N
ATLANTA GA
30350-2995
US

IV. Provider business mailing address

987 TROPHY CLUB AVE
DACULA GA
30019-7585
US

V. Phone/Fax

Practice location:
  • Phone: 413-212-0193
  • Fax:
Mailing address:
  • Phone: 413-212-0193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10041714
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN248628
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: