Healthcare Provider Details

I. General information

NPI: 1740661180
Provider Name (Legal Business Name): RACHEL MARIE RISNER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL MARIE RISNER DO

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 TURNER MCCALL BLVD SW
ROME GA
30165-5621
US

IV. Provider business mailing address

7450 HICKORY BLUFF DRIVE
CUMMING GA
30040
US

V. Phone/Fax

Practice location:
  • Phone: 706-509-5000
  • Fax:
Mailing address:
  • Phone: 770-530-3511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number82670
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number82670
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: