Healthcare Provider Details

I. General information

NPI: 1083871834
Provider Name (Legal Business Name): ANDREW L. RAY P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3051 WATSON BLVD SUITE 525
WARNER ROBINS GA
31093-8536
US

IV. Provider business mailing address

120 OSIGIAN BLVD SUITE 100
WARNER ROBINS GA
31088-7880
US

V. Phone/Fax

Practice location:
  • Phone: 478-953-4563
  • Fax: 478-953-4683
Mailing address:
  • Phone: 478-953-5358
  • Fax: 478-953-5340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number005322
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: