Healthcare Provider Details

I. General information

NPI: 1164600078
Provider Name (Legal Business Name): RAPHA HEALTHCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 WALKER DR
SPRINGVILLE AL
35146-3250
US

IV. Provider business mailing address

480 WALKER DR P O BOX 529
SPRINGVILLE AL
35146-3250
US

V. Phone/Fax

Practice location:
  • Phone: 205-467-6919
  • Fax: 205-467-7088
Mailing address:
  • Phone: 205-467-6919
  • Fax: 205-467-7088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13393
License Number StateAL

VIII. Authorized Official

Name: DR. GEORGE M HARRIS
Title or Position: OWNER
Credential: M.D.
Phone: 205-467-6919