Healthcare Provider Details

I. General information

NPI: 1083064539
Provider Name (Legal Business Name): RACHAEL L SWEENEY NP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W GORDON ST
THOMASTON GA
30286-3426
US

IV. Provider business mailing address

72 MUSTANG TRL
WAVERLY HALL GA
31831-2399
US

V. Phone/Fax

Practice location:
  • Phone: 706-647-8111
  • Fax:
Mailing address:
  • Phone: 801-842-3776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WF0300X
TaxonomyFlight Registered Nurse
License NumberRN199221
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN199221
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN199221
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN199221
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: