Healthcare Provider Details

I. General information

NPI: 1326336736
Provider Name (Legal Business Name): RAYMOND C MCKOY, DO, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W 10TH ST NE
ROME GA
30165-2639
US

IV. Provider business mailing address

310 W 10TH ST NE
ROME GA
30165-2639
US

V. Phone/Fax

Practice location:
  • Phone: 512-434-9064
  • Fax:
Mailing address:
  • Phone: 706-346-2130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number044536
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RAYMOND CLAYTON MCKOY
Title or Position: PHYSICIAN
Credential: DO
Phone: 706-346-2130