Healthcare Provider Details

I. General information

NPI: 1285668574
Provider Name (Legal Business Name): RAY B. PARIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 COMMERCE PL SUITE 1
BARNESVILLE GA
30204-1680
US

IV. Provider business mailing address

643 MAIN ST
PALMETTO GA
30268-1138
US

V. Phone/Fax

Practice location:
  • Phone: 770-358-4408
  • Fax: 770-358-0002
Mailing address:
  • Phone: 404-929-8824
  • Fax: 404-929-9769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19855
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: