Healthcare Provider Details

I. General information

NPI: 1366804544
Provider Name (Legal Business Name): AL WILLIAM RAY III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HOSPITAL BLVD STE 290
ROSWELL GA
30076-4918
US

IV. Provider business mailing address

2500 HOSPITAL BLVD STE 290
ROSWELL GA
30076-4918
US

V. Phone/Fax

Practice location:
  • Phone: 470-956-4230
  • Fax:
Mailing address:
  • Phone: 470-956-4230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number92649
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: