Healthcare Provider Details

I. General information

NPI: 1619207040
Provider Name (Legal Business Name): RACHEL MICHELE BRIGHTWELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2010
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

771 OLD NORCROSS RD STE 165
LAWRENCEVILLE GA
30046-4979
US

IV. Provider business mailing address

1609 BERNINI PL
BRENTWOOD TN
37027-6144
US

V. Phone/Fax

Practice location:
  • Phone: 678-442-3121
  • Fax: 678-376-4045
Mailing address:
  • Phone: 512-815-0972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number67338
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberQ9127
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number102575
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: