=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689317059
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RACHEL BENTLEY MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2022
-----------------------------------------------------
Last Update Date | 06/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7710 MCGINNIS FERRY RD
-----------------------------------------------------
City | SUWANEE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30024-1622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-268-4361
-----------------------------------------------------
Fax | 470-251-6068
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3333 RIVERWOOD PKWY SE STE 250
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30339-3304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-914-0116
-----------------------------------------------------
Fax | 770-955-4278
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 103201
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------