Healthcare Provider Details

I. General information

NPI: 1982258141
Provider Name (Legal Business Name): RACHEL DONNELLY DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2019
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 JOHN WESLEY GILBERT DR
AUGUSTA GA
30912-8941
US

IV. Provider business mailing address

673 SHORTWOOD ST
CHARLESTON SC
29412-9027
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-2371
  • Fax:
Mailing address:
  • Phone: 843-737-3824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number9452
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9452
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: