Provider Demographics
NPI:1588109581
Name:WAITS, REBECCA (RN, CDE)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:WAITS
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 TURNER MCCALL BLVD SW
Mailing Address - Street 2:330 PHYSICIANS CENTER SUITE 104
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-5621
Mailing Address - Country:US
Mailing Address - Phone:706-509-5184
Mailing Address - Fax:706-292-7577
Practice Address - Street 1:304 TURNER MCCALL BLVD SW
Practice Address - Street 2:330 PHYSICIANS CENTER, SUITE 104
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-5621
Practice Address - Country:US
Practice Address - Phone:706-509-5184
Practice Address - Fax:706-292-7577
Is Sole Proprietor?:No
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN098279163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator