Healthcare Provider Details

I. General information

NPI: 1073805974
Provider Name (Legal Business Name): RACHEL ELIZABETH BLANCHARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 NORTHSIDE FORSYTH DR
CUMMING GA
30041-7659
US

IV. Provider business mailing address

104 N MURRAY HILL RD
COLUMBUS OH
43228-1524
US

V. Phone/Fax

Practice location:
  • Phone: 770-844-3200
  • Fax: 770-844-3227
Mailing address:
  • Phone: 614-878-6413
  • Fax: 614-878-1159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number011153
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number34.011153
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number077708
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: