MEDICARE: RALEIGH PROFESSIONAL ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2800X	Methadone Clinic	0000000036	TN

General Provider Information

NPI Number	:	1871752105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RALEIGH PROFESSIONAL ASSOCIATES

Provider Business Mailing Address
First Line	:	1869 HIGHWAY 45 BYP
Second Line	:	SUITE 5
City	:	JACKSON
State	:	TN
Zip	:	38305-2464
Country	:	US
Telephone Number	:	731-660-0880
Fax Number	:	731-668-0380

Provider Business Practice Location Address
First Line	:	1869 HIGHWAY 45 BYP
Second Line	:	SUITE 5
City	:	JACKSON
State	:	TN
Zip	:	38305-2464
Country	:	US
Telephone Number	:	731-660-0880
Fax Number	:	731-668-0380

Authorized Official
Title or Position	:	PROGRAM SPONSOR
Name	:	BARBARA KAY DOTY
Credential	:
Telephone Number	:	901-372-7878

Provider Enumeration Date	:	06/02/2008
Last Update Date	:	06/02/2008

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