Healthcare Provider Details

I. General information

NPI: 1487683454
Provider Name (Legal Business Name): EMILY J RAYES-PRINCE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMILY JANE RAYES MD

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 03/07/2023
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2208 W ROOSEVELT BLVD
MONROE NC
28110-2762
US

IV. Provider business mailing address

108 GROVE ST STE 200
WORCESTER MA
01605-2651
US

V. Phone/Fax

Practice location:
  • Phone: 704-289-9869
  • Fax:
Mailing address:
  • Phone: 833-963-2102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number33653
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberKY33653
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number2009-01802
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number33653
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: