Healthcare Provider Details

I. General information

NPI: 1457742645
Provider Name (Legal Business Name): REBECCA TAUNTON RN, BSN, RNFA, CNOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 02/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 BIRCH CIR
FORSYTH GA
31029-5521
US

IV. Provider business mailing address

123 LAGRANGE PL
MACON GA
31210-1473
US

V. Phone/Fax

Practice location:
  • Phone: 843-822-8787
  • Fax:
Mailing address:
  • Phone: 843-822-8787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN194812
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: