Healthcare Provider Details

I. General information

NPI: 1245608124
Provider Name (Legal Business Name): EKTA RANI RATHEE DNP, PMHNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 NORTHSIDE FORSYTH DR
CUMMING GA
30041-7659
US

IV. Provider business mailing address

1200 NORTHSIDE FORSYTH DR
CUMMING GA
30041-7659
US

V. Phone/Fax

Practice location:
  • Phone: 770-844-3200
  • Fax: 770-844-3227
Mailing address:
  • Phone: 770-844-3200
  • Fax: 770-844-3227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3015522
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3015522
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberGAA-NP001603
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: