Healthcare Provider Details

I. General information

NPI: 1881137149
Provider Name (Legal Business Name): DEBORAH RAMONA RACADAG BSN-RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH RAMONA MILLER BSN-RN

II. Dates (important events)

Enumeration Date: 11/18/2016
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 GOLDEN HILLS DRIVE SUITE D
MOUNTAIN CITY GA
30562
US

IV. Provider business mailing address

PO BOX 1170
CLAYTON GA
30525-0030
US

V. Phone/Fax

Practice location:
  • Phone: 706-613-4485
  • Fax:
Mailing address:
  • Phone: 706-613-4485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN263751
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: