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General NPI Number Information
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NPI Number | 1376892802
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Entity Type | Individual
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Provider Name | NANCY RABORN FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/30/2012
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Last Update Date | 01/19/2016
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Provider Practice Location Address
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Address Line | 125 EAGLE SPRING DR
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-6328
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Country | US
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Telephone | 770-213-3366
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Fax | 855-516-2317
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Provider Business Mailing Address
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Address Line | 1065 LULLWATER CIR
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City | MCDONOUGH
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State | GA
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Zip | 30253-5576
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Country | US
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Telephone |
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Fax | 706-836-3338
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 136892
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License Number State | GA
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