Healthcare Provider Details

I. General information

NPI: 1871529032
Provider Name (Legal Business Name): PATRICK BRYAN RAILEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 FISCHER MARKETPLACE LN STE 100
SHARPSBURG GA
30277-3680
US

IV. Provider business mailing address

PO BOX 102321
ATLANTA GA
30368-2321
US

V. Phone/Fax

Practice location:
  • Phone: 678-633-3260
  • Fax:
Mailing address:
  • Phone: 770-801-2500
  • Fax: 770-803-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number043114
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: