Provider Demographics
NPI:1285436881
Name:METZGER, MARY RACHEL
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:RACHEL
Last Name:METZGER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:RACHEL
Other - Last Name:BONNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:777 HEMLOCK ST # 167
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2102
Mailing Address - Country:US
Mailing Address - Phone:478-633-1710
Mailing Address - Fax:
Practice Address - Street 1:777 HEMLOCK ST # 167
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2102
Practice Address - Country:US
Practice Address - Phone:478-633-1710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program