Healthcare Provider Details

I. General information

NPI: 1780609917
Provider Name (Legal Business Name): RACHEL LAUREN DUNCAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL LAUREN HAWKINS

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 WELLNESS WAY STE 7120
ST SIMONS ISLAND GA
31522-2286
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 912-634-4966
  • Fax: 912-634-6542
Mailing address:
  • Phone: 920-663-9008
  • Fax: 920-684-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number004773
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: