Healthcare Provider Details

I. General information

NPI: 1427041631
Provider Name (Legal Business Name): RAYMOND HOWARD III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date: 03/27/2006
Reactivation Date: 04/05/2006

III. Provider practice location address

107 JOHN MADDOX DRIVE
ROME GA
30165-1494
US

IV. Provider business mailing address

107 JOHN MADDOX DRIVE
ROME GA
30165-1494
US

V. Phone/Fax

Practice location:
  • Phone: 706-235-0116
  • Fax: 706-235-5533
Mailing address:
  • Phone: 706-235-0116
  • Fax: 706-235-5533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number051145
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number51145
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: