Healthcare Provider Details

I. General information

NPI: 1326501032
Provider Name (Legal Business Name): RACHEL MICHELE SPIVEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RACHEL MICHELE YANKOWSKI

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 CHURCH ST NE
MARIETTA GA
30060-1101
US

IV. Provider business mailing address

531 ROSELANE ST NW STE 830
MARIETTA GA
30060-6979
US

V. Phone/Fax

Practice location:
  • Phone: 770-794-0477
  • Fax:
Mailing address:
  • Phone: 770-794-0477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN-CRNA191657
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN191657
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: