Healthcare Provider Details

I. General information

NPI: 1265132286
Provider Name (Legal Business Name): AUSTIN GLEN RAWLINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 LANIER 400 PKWY # A
CUMMING GA
30040-2539
US

IV. Provider business mailing address

PO BOX 543
ZEBULON GA
30295-0543
US

V. Phone/Fax

Practice location:
  • Phone: 770-205-1294
  • Fax:
Mailing address:
  • Phone: 770-584-8371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN283400
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: