Rebecca Li
Individual provider Active NPI Family Nurse Practitioner · Clarkston, GA
NPI 1457059834 · NPPES record last updated Feb 23, 2023
Key facts
- NPI
- 1457059834
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- RN306685 (GA)
- Practice address
- 980 Rowland St Ste 4190
Clarkston, GA 30021-2203 - Phone
- (470) 799-0044
- NPI assigned
- Feb 16, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Emory University School of Medicine, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Ethne Health, Inc
Practice addresses (Care Compare)
980 Rowland St
Suite 4190
Clarkston, GA 30021-2203
Phone (470) 799-0044
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230323002938 | GA | Practitioner - Nurse Practitioner | 5890169379 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ethne Health, Inc | Current |
Accepting new patients | |
| Ethne Health | Past |
Accepting new patients |
Locations
980 Rowland St
#4190
Clarkston, GA 30021
Phone (470) 799-0044
Interoperability endpoints
- https://api.platform.athenahealth.com/18426/brand/1/csg/1/fhir/r4
- rebecca.li.1@18426.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | RN306685 | GA | Yes |
Addresses
Primary practice location
980 Rowland St Ste 4190
Clarkston, GA 30021-2203
Mailing address
4692 E Ponce de Leon Ave Apt 5312
Stone Mountain, GA 30083-1323
Other providers in Clarkston, GA
- Marilyn Cecelia Kimble
- Robert Marc Kleiner
- Emily Schober Klingman
- Latrice Shanee Lawrence
- Joyce Rochelle Lewis
- Lifeline Medical Center, LLC
- Linco Healthcare System LLC
- Sean R Lindsey
- Ashenafi Mariye
- Raven Martinez
All providers in Clarkston, GA · Family Nurse Practitioner in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 23, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.