Healthcare Provider Details

I. General information

NPI: 1811333784
Provider Name (Legal Business Name): RACHEL RUSSELL MEADORS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2013
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S MADISON ST
THOMASVILLE GA
31792-5473
US

IV. Provider business mailing address

1100 7TH AVE
JASPER AL
35501
US

V. Phone/Fax

Practice location:
  • Phone: 229-221-9552
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN286724
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: