Provider Demographics
NPI:1922540277
Name:RACADAG, IRA STEVEN (APRN)
Entity type:Individual
Prefix:MR
First Name:IRA
Middle Name:STEVEN
Last Name:RACADAG
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:125 N MAIN ST UNIT 1170
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:GA
Mailing Address - Zip Code:30525-4698
Mailing Address - Country:US
Mailing Address - Phone:706-613-4485
Mailing Address - Fax:762-212-4368
Practice Address - Street 1:95 GOLDEN HILLS DR. STE. D
Practice Address - Street 2:
Practice Address - City:MOUNTAIN CITY
Practice Address - State:GA
Practice Address - Zip Code:30562-2025
Practice Address - Country:US
Practice Address - Phone:706-613-4485
Practice Address - Fax:762-212-4368
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN264829363LP0808X
FLAPRN11015334363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty