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General NPI Number Information
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NPI Number | 1922540277
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Entity Type | Individual
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Provider Name | IRA STEVEN RACADAG APRN
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Gender | Male
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Dates
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Enumeration Date | 11/16/2016
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 95 GOLDEN HILLS DR. STE. D
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City | MOUNTAIN CITY
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State | GA
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Zip | 30562-2025
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Country | US
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Telephone | 706-613-4485
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Fax | 762-212-4368
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Provider Business Mailing Address
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Address Line | 125 N MAIN ST UNIT 1170
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City | CLAYTON
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State | GA
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Zip | 30525-4698
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Country | US
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Telephone | 706-613-4485
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Fax | 762-212-4368
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN264829
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11015334
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License Number State | FL
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