Provider Demographics
NPI:1063690964
Name:PRATHER, DEBORAH (FNP-C)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:PRATHER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 N EXPRESSWAY
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-2073
Mailing Address - Country:US
Mailing Address - Phone:943-202-7790
Mailing Address - Fax:470-986-7152
Practice Address - Street 1:509 N EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-2073
Practice Address - Country:US
Practice Address - Phone:943-202-7790
Practice Address - Fax:470-986-7152
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN123825363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
12354545OtherCAQH
GA003205587AMedicaid
GA061407OtherBC/BS OF GA GROUP #
GA944973215DMedicaid
GA511I500983Medicare PIN