Individual provider Active NPI

Rachel Koller, FNP-C

  • Nurse Practitioner
  • Roswell, GA
National Provider Identifier
1821843079
Registry record updated Dec 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN315500 Issued in GA
Practice address
1357 Hembree Rd Ste 250
Roswell, GA 30076-5724
Phone
(770) 754-0787
NPI assigned
Apr 22, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN315500 GA Primary

Addresses

Primary practice location

1357 Hembree Rd Ste 250
Roswell, GA 30076-5724

Mailing address

1357 Hembree Rd Ste 250
Roswell, GA 30076-5724
Phone (770) 754-0787

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241119000790 GA Practitioner - Nurse Practitioner 6305371048 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Emory University School of Medicine, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aqua Dermatology of Georgia PCGroup PAC ID 6800885757, 56 clinicians

Practice addresses (Care Compare)

835 Cogburn Ave NW
Suite 100
Marietta, GA 30060-1008
Phone (770) 422-5557

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Dermatopathology Lab of Skin Cancer Specialists, P.C. CurrentSince Sep 1, 2024 Accepting new patients
Aqua Dermatology of Georgia PC CurrentSince Sep 1, 2024 Accepting new patients

Locations

1255 Friendship Rd
Ste 120
Braselton, GA 30517
Phone (470) 201-7777

1839 Buford Hwy
Ste 100
Buford, GA 30518
Phone (678) 450-9933

470 Northside Cherokee Blvd
Ste 170
Canton, GA 30115
Phone (770) 721-9540

2870 Ronald Reagan Blvd
Ste 103
Cumming, GA 30041
Phone (248) 601-4900

5983 Highway 53 E
Ste 200
Dawsonville, GA 30534
Phone (770) 754-0787

601 Professional Dr
Ste 200
Lawrenceville, GA 30046
Phone (470) 242-0726

835 Cogburn Ave NW
Ste 100
Marietta, GA 30060
Phone (770) 422-5557

835 Cogburn Ave NW
Ste 250
Marietta, GA 30060
Phone (770) 422-8815

1163 Johnson Ferry Rd
Ste 250
Marietta, GA 30068
Phone (770) 321-1001

2500 Hospital Blvd
Ste 280
Roswell, GA 30076
Phone (770) 754-0787

1357 Hembree Rd
Ste 250
Roswell, GA 30076
Phone (770) 475-7550

4298 Atlanta Rd SE
Ste 320
Smyrna, GA 30080
Phone (404) 252-5669

2001 Professional Way
Ste 250
Woodstock, GA 30188
Phone (770) 754-0787

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1713744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734566400000",
    "number": "1821843079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1357 HEMBREE RD STE 250",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300765724",
            "telephone_number": "770-754-0787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1357 HEMBREE RD STE 250",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300765724",
            "telephone_number": "770-754-0787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLLER",
        "first_name": "RACHEL",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-22",
        "last_updated": "2024-12-19",
        "certification_date": "2024-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN315500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, GA

Sources for this page

Verify at the official NPI Registry.