Healthcare Provider Details

I. General information

NPI: 1184446973
Provider Name (Legal Business Name): RAQUEL MCNEAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JOHNSON FERRY RD
MARIETTA GA
30068-2114
US

IV. Provider business mailing address

2690 COBB PKWY SE STE A5-108
SMYRNA GA
30080-3001
US

V. Phone/Fax

Practice location:
  • Phone: 213-716-6386
  • Fax:
Mailing address:
  • Phone: 213-716-6386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number24159001
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: