Healthcare Provider Details

I. General information

NPI: 1720079940
Provider Name (Legal Business Name): SETH D RAYBURN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 W MARKET ST STE C
ATHENS AL
35611-2463
US

IV. Provider business mailing address

PO BOX 630
ATHENS AL
35612-0630
US

V. Phone/Fax

Practice location:
  • Phone: 256-216-6500
  • Fax: 256-216-8777
Mailing address:
  • Phone: 256-216-6500
  • Fax: 256-216-8777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number23684
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: