Healthcare Provider Details

I. General information

NPI: 1841785243
Provider Name (Legal Business Name): RACHEL ANN MCEATHRON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL ANN COOLEY PA-C

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MILLER ST STE C
WINSTON SALEM NC
27104-4206
US

IV. Provider business mailing address

PO BOX 601843
CHARLOTTE NC
28260-1843
US

V. Phone/Fax

Practice location:
  • Phone: 336-310-5535
  • Fax: 336-310-1183
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0010-08180
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number236954
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-08180
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: