MEDICARE: REBEKAH SOROOSH CORLEY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0010-03918	NC

General Provider Information

NPI Number	:	1023352358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBEKAH SOROOSH CORLEY PA-C

Provider Business Mailing Address
First Line	:	3320 OLD JEFFERSON RD BLDG 800
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30607-1400
Country	:	US
Telephone Number	:	706-353-2990
Fax Number	:

Provider Business Practice Location Address
First Line	:	658 N CHASE ST STE 201
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30601-1960
Country	:	US
Telephone Number	:	706-353-2990
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2012
Last Update Date	:	07/16/2024

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