Healthcare Provider Details

I. General information

NPI: 1386281806
Provider Name (Legal Business Name): DEBORAH LYNN RAYNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2019
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 GRANT WAY
ROCKY FACE GA
30740-8824
US

IV. Provider business mailing address

1107 GRANT WAY
ROCKY FACE GA
30740-8824
US

V. Phone/Fax

Practice location:
  • Phone: 423-580-2341
  • Fax:
Mailing address:
  • Phone: 423-580-2341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN089341
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: