Healthcare Provider Details

I. General information

NPI: 1407091499
Provider Name (Legal Business Name): WALAYA CHIYEM METHODIUS-RAYFORD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WALAYA CHIYEM METHODIUS-NGWODO MD

II. Dates (important events)

Enumeration Date: 12/05/2008
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11050 CRABAPPLE RD STE 105B
ROSWELL GA
30075-2456
US

IV. Provider business mailing address

11050 CRABAPPLE RD STE 105B
ROSWELL GA
30075-2456
US

V. Phone/Fax

Practice location:
  • Phone: 317-679-7868
  • Fax:
Mailing address:
  • Phone: 317-679-7868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number061985
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: