Healthcare Provider Details

I. General information

NPI: 1477121036
Provider Name (Legal Business Name): REBECCA PODSTATA FAIN ADVANCED PRACTICE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 N DECATUR RD
DECATUR GA
30033-5918
US

IV. Provider business mailing address

2701 N DECATUR RD
DECATUR GA
30033-5918
US

V. Phone/Fax

Practice location:
  • Phone: 404-501-1624
  • Fax: 404-252-4755
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number231274
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberRN231274
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: